Objective To compare short term surgical outcomes between male and female gastrointestinal surgeons in Japan. Design Retrospective cohort study. Setting Data from the Japanese National Clinical Database (includes data on >95% of surgeries performed in Japan) (2013-17) and the Japanese Society of Gastroenterological Surgery. Participants Male and female surgeons who performed distal gastrectomy, total gastrectomy, and low anterior resection. Main outcome measures Surgical mortality, surgical mortality combined with postoperative complications, pancreatic fistula (distal gastrectomy/total gastrectomy only), and anastomotic leakage (low anterior resection only). The association of surgeons’ gender with surgery related mortality and surgical complications was examined using multivariable logistic regression models adjusted for patient, surgeon, and hospital characteristics. Results A total of 149 193 distal gastrectomy surgeries (male surgeons: 140 971 (94.5%); female surgeons: 8222 (5.5%)); 63 417 gastrectomy surgeries (male surgeons: 59 915 (94.5%); female surgeons: 3502 (5.5%)); and 81 593 low anterior resection procedures (male surgeons: 77 864 (95.4%); female surgeons: 3729 (4.6%)) were done. On average, female surgeons had fewer post-registration years, operated on patients at higher risk, and did fewer laparoscopic surgeries than male surgeons. No significant difference was found between male and female surgeons in the adjusted risk for surgical mortality (adjusted odds ratio 0.98 (95% confidence interval 0.74 to 1.29) for distal gastrectomy; 0.83 (0.57 to 1.19) for total gastrectomy; 0.56 (0.30 to 1.05) for low anterior resection), surgical mortality combined with Clavien-Dindo grade ≥3 complications (adjusted odds ratio 1.03 (0.93 to 1.14) for distal gastrectomy; 0.92 (0.81 to 1.05) for total gastrectomy; 1.02 (0.91 to 1.15) for low anterior resection), pancreatic fistula (adjusted odds ratio 1.16 (0.97 to 1.38) for distal gastrectomy; 1.02 (0.84 to 1.23) for total gastrectomy), and anastomotic leakage (adjusted odds ratio 1.04 (0.92 to 1.18) for low anterior resection). Conclusion This study found no significant adjusted risk difference in the outcomes of surgeries performed by male versus female gastrointestinal surgeons. Despite disadvantages, female surgeons take on patients at high risk. Greater access to surgical training for female physicians is warranted in Japan. Data on individual surgical cases and surgeons reported in this study are not publicly available. Aggregate data, including data reported in this study, can be accessed by submitting a research plan to the NCD Office and requesting access, usually through an NCD related society (such as the JSGS). If the proposal is approved, the de-identified data (including participant and related data, if necessary) can be assessed by a statistics specialist affiliated with the NCD.

中文翻译：

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日本男性和女性胃肠外科医生短期手术结果的比较：回顾性队列研究

目的比较日本男性和女性胃肠外科医生的短期手术效果。设计回顾性队列研究。来自日本国家临床数据库（包括在日本进行的 >95% 手术的数据）（2013-17 年）和日本胃肠外科学会的设置数据。参与者 进行远端胃切除术、全胃切除术和低位前切除术的男性和女性外科医生。主要结果测量手术死亡率、手术死亡率合并术后并发症、胰瘘（仅远端胃切除术/全胃切除术）和吻合口漏（仅低位前切除术）。外科医生的性别与手术相关死亡率和手术并发症的关联使用针对患者、外科医生、和医院特色。结果共149 193例远端胃切除手术（男性外科医生：140 971（94.5%）；女性外科医生：8222（5.5%））；63 417 例胃切除手术（男性外科医生：59 915 (94.5%)；女性外科医生：3502 (5.5%)）；完成了 81 593 例低位前切除手术（男性外科医生：77 864 人（95.4%）；女性外科医生：3729 人（4.6%））。平均而言，与男性外科医生相比，女性外科医生的注册后年限更少，为高风险患者进行手术，并且进行的腹腔镜手术更少。男性和女性外科医生的手术死亡率调整风险无显着差异（远端胃切除术的调整优势比为 0.98（95% 置信区间 0.74 至 1.29）；全胃切除术为 0.83（0.57 至 1.19）；0.56（0.30 至 1.05） ) 用于低位前切除术), 手术死亡率合并 Clavien-Dindo ≥3 级并发症（远端胃切除术的调整优势比为 1.03（0.93 至 1.14）；全胃切除术为 0.92（0.81 至 1.05）；低位前切除术为 1.02（0.91 至 1.15）），胰瘘（远端胃切除术的调整优势比为 1.16（0.97 至 1.38）；全胃切除术为 1.02（0.84 至 1.23），吻合口漏（低位前切除术的调整优势比为 1.04（0.92 至 1.18））。结论 本研究发现男性和女性胃肠外科医生的手术结果没有显着的调整风险差异。尽管有不利条件，但女外科医生仍会接受高风险患者。在日本，有必要为女性医生提供更多的外科培训机会。本研究报告的个别手术病例和外科医生的数据不公开。汇总数据，包括本研究中报告的数据，可以通过向 NCD 办公室提交研究计划并请求访问来访问，通常是通过 NCD 相关协会（例如 JSGS）。如果提案获得批准，去标识化的数据（包括参与者和相关数据，如有必要）可以由隶属于 NCD 的统计专家进行评估。