Abstract
BACKGROUND: Previous research has suggested that female surgeons achieve better outcomes in various procedures, but the underlying reasons remain unclear. This study aimed to explore potential explanations for observed gender disparities in cholecystectomy outcomes. METHODS: A follow-up analysis was conducted using a previously reported population-based cohort from the Swedish Registry of Gallstone Surgery. All patients who underwent cholecystectomy in Sweden between 2007 and 2019 were included, with a subgroup (2017-2019) analysed for case mix. The association between surgeon gender and outcomes was assessed, considering caseload, case mix, team composition, and surgeon-patient gender dynamics. RESULTS: The analysis included 150 509 cholecystectomies performed by 2555 surgeons (849 women, 1706 men). Female surgeons had fewer complications across all experience categories. The gender disparity in bile duct injuries was most notable among male surgeons with < 3 years of experience (risk ratio 1.77, 95% confidence interval 1.30 to 2.40). After adjusting for case mix, male surgeons had higher risks of surgical complications (risk ratio 1.28, 95% confidence interval 1.12 to 1.45), bile duct injuries (risk ratio 1.63, 95% confidence interval 1.01 to 2.62), and total complications (risk ratio 1.10, 95% confidence interval 1.03 to 1.19), but shorter operating times. Teams with only male surgeons had the highest complication rates. Women experienced the best outcomes when treated by female surgeons. CONCLUSION: Female surgeons were associated with more favourable cholecystectomy outcomes. These differences persisted after accounting for caseload, case mix, and team composition. Inexperienced male surgeons had a higher risk of bile duct injury, underscoring the importance of rigorous mentorship during the early years of practice.