Surgical Cancelations and Postponements by Surgeon and Patient Sex: A Retrospective Cohort Study in Alberta, Canada.

Abstract

To estimate the association between surgeon sex with surgical postponements or cancelations. Female surgeons receive lower hourly, per-patient, and total compensation than their male colleagues. Bias in the decision to postpone or cancel surgical cases may contribute to compensation inequality, since this results in unpaid surgeon time. This retrospective cohort study used administrative health data to identify surgeries performed at 4 hospitals in Calgary, Alberta, Canada, that were canceled or postponed due to surgeon/operating room overbooking or to accommodate an emergency case between April 1, 2015 and March 31, 2020. Surgeries performed in dedicated operating or procedure rooms (eg, bronchoscopy, cardiac surgery, etc) were excluded. The exposure of interest was surgeon sex, identified by matching their name to the provincial regulatory body record of self-identified sex, which allowed for selection between female and male only during the time of this study. There were 214,832 eligible surgical cases, of which 1481 and 2473 were postponed or canceled due to overbooking and to accommodate an emergency, respectively. After adjusting for surgical specialty, whether the procedure was a day case, and for patient sex, female surgeons were more likely to be canceled or postponed to accommodate an emergency case compared with male surgeons (odds ratio: 1.21, 95% CI: 1.05-1.38). There may be sex bias in the decision about which surgical cases to postpone or cancel to accommodate emergency surgeries in our setting. This bias may contribute to compensation inequality in a fee-for-service setting.