Surgeon gender and outcomes in the management of pediatric appendicitis

Adult studies suggest surgeon gender influences postoperative outcomes. The objective of this study was to assess whether surgeon gender and surgeon-patient gender concordance affect postoperative outcomes and resource use in pediatric appendectomy.

This was a retrospective cohort study of children undergoing appendectomy (7/2015-6/2020) using NSQIP-Pediatric data from 13 hospitals participating in a regional research consortium. Primary exposure was surgeon gender. Outcomes included 30-day surgical site infection (SSI), reoperation, percutaneous drainage, hospital revisits, postoperative imaging, operative duration, and length of stay. Mixed-effects multivariable regression models adjusted for patient, surgeon and hospital-level factors.

The cohort included 7695 children. Female surgeons comprised 26.3% (31/118) of surgeons, performed 30.1% (2317/7695) of appendectomies, and had fewer mean years in practice than male surgeons (8.9 vs 13.4 years; P < 0.001). Surgeon gender was not associated with SSI (3.8% [88/2317] vs 3.9% [212/5378]; adjusted odds ratio [aOR] 1.13; 95% CI, 0.85-1.51), reoperation (1.1% [26/2317] vs 1.2% [65/5378]; aOR, 1.09; 95% CI, 0.67-1.77), or percutaneous drainage (3.0% [70/2317] vs 3.7% [197/5378]; aOR, 1.30; 95% CI, 0.95-1.79). No associations were observed for hospital revisits (aOR, 1.07; 95% CI, 0.88-1.30), postoperative imaging (aOR, 0.98; 95% CI, 0.79-1.21), operative duration (adjusted mean ratio [aMR], 1.00; 95% CI, 0.96-1.04), or length of stay (aMR, 1.04; 95% CI, 0.96-1.13). Findings were consistent in subgroup analyses of complicated appendicitis and surgeon-patient gender concordance.

Surgeon gender and surgeon-patient gender concordance is not associated with postoperative outcomes or resource utilization in pediatric appendectomy.