DOI: 10.1001/jamasurg.2023.6031 ISSN: 2168-6254

Surgeon Sex and Health Care Costs for Patients Undergoing Common Surgical Procedures

Christopher J. D. Wallis, Angela Jerath, Khatereh Aminoltejari, Kirusanthy Kaneshwaran, Arghavan Salles, Melinda Beeuwkes Buntin, Natalie G. Coburn, Frances C. Wright, Lesley Gotlib Conn, Kiyan Heybati, Amy N. Luckenbaugh, Sanjana Ranganathan, Carlos Riveros, Colin McCartney, Kathleen A. Armstrong, Barbara L. Bass, Allan S. Detsky, Raj Satkunasivam
  • Surgery


Prior research has shown differences in postoperative outcomes for patients treated by female and male surgeons. It is important to understand, from a health system and payer perspective, whether surgical health care costs differ according to the surgeon’s sex.


To examine the association between surgeon sex and health care costs among patients undergoing surgery.

Design, Setting, and Participants

This population-based, retrospective cohort study included adult patients undergoing 1 of 25 common elective or emergent surgical procedures between January 1, 2007, and December 31, 2019, in Ontario, Canada. Analysis was performed from October 2022 to March 2023.


Surgeon sex.

Main Outcome and Measure

The primary outcome was total health care costs assessed 1 year following surgery. Secondarily, total health care costs at 30 and 90 days, as well as specific cost categories, were assessed. Generalized estimating equations were used with procedure-level clustering to compare costs between patients undergoing equivalent surgeries performed by female and male surgeons, with further adjustment for patient-, surgeon-, anesthesiologist-, hospital-, and procedure-level covariates.


Among 1 165 711 included patients, 151 054 were treated by a female surgeon and 1 014 657 were treated by a male surgeon. Analyzed at the procedure-specific level and accounting for patient-, surgeon-, anesthesiologist-, and hospital-level covariates, 1-year total health care costs were higher for patients treated by male surgeons ($24 882; 95% CI, $20 780-$29 794) than female surgeons ($18 517; 95% CI, $16 080-$21 324) (adjusted absolute difference, $6365; 95% CI, $3491-9238; adjusted relative risk, 1.10; 95% CI, 1.05-1.14). Similar patterns were observed at 30 days (adjusted absolute difference, $3115; 95% CI, $1682-$4548) and 90 days (adjusted absolute difference, $4228; 95% CI, $2255-$6202).

Conclusions and Relevance

This analysis found lower 30-day, 90-day, and 1-year health care costs for patients treated by female surgeons compared with those treated by male surgeons. These data further underscore the importance of creating inclusive policies and environments supportive of women surgeons to improve recruitment and retention of a more diverse and representative workforce.

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