Association Between Surgeon and Anesthesiologist Sex Discordance and Postoperative Outcomes: A Population-based Cohort Study

Christopher J.D. Wallis, Angela Jerath, Kirusanthy Kaneshwaran, Julie Hallet, Natalie Coburn, Frances C. Wright, Lesley Gotlib Conn, Danielle Bischof, Andrea Covelli, Zachary Klaassen, Alexandre R. Zlotta, Girish S. Kulkarni, Amy N. Luckenbaugh, Kathleen Armstrong, Kelvin Lim, Barbara Bass, Allan S. Detsky, Raj Satkunasivam

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Objective:The aim of this study was to examine the effect of surgeon-anesthesiologist sex discordance on postoperative outcomes.Summary Background Data:Optimal surgical outcomes depend on teamwork, with surgeons and anesthesiologists forming two key components. There are sex and sex-based differences in interpersonal communication and medical practice which may contribute to patients' perioperative outcomes.Methods:We performed a population-based, retrospective cohort study among adult patients undergoing 1 of 25 common elective or emergent surgical procedures from 2007 to 2019 in Ontario, Canada. We assessed the association between differences in sex between surgeon and anesthesiologists (sex discordance) on the primary endpoint of adverse postoperative outcome, defined as death, readmission, or complication within 30-days following surgery using generalized estimating equations.Results:Among 1,165,711 patients treated by 3006 surgeons and 1477 anesthesiologists, 791,819 patients were treated by sex concordant teams (male surgeon/male anesthesiologist: 747,327 and female surgeon/female anesthesiologist: 44,492), whereas 373,892 were sex discordant (male surgeon/female anesthesiologist: 267,330 and female surgeon/male anesthesiologist: 106,562). Overall, 12.3% of patients experienced >1 adverse postoperative outcomes of whom 1.3% died. Sex discordance between surgeon and anesthesiologist was not associated with a significant increased likelihood of composite adverse postoperative outcomes (adjusted odds ratio 1.00, 95% confidence interval 0.97-1.03).Conclusions:We did not demonstrate an association between intraoperative surgeon and anesthesiologist sex discordance on adverse postoperative outcomes in a large patient cohort. Patients, clinicians, and administrators may be reassured that physician sex discordance in operating room teams is unlikely to clinically meaningfully affect patient outcomes after surgery.

Original languageEnglish (US)
Pages (from-to)81-87
Number of pages7
JournalAnnals of surgery
Issue number1
StatePublished - Jul 1 2022


  • anesthesiologist
  • communication
  • readmission
  • surgeon
  • treatment outcome
  • Humans
  • Postoperative Period
  • Male
  • Ontario/epidemiology
  • Postoperative Complications/epidemiology
  • Surgeons
  • Adult
  • Female
  • Retrospective Studies
  • Cohort Studies

ASJC Scopus subject areas

  • Surgery


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