Journal Article
Sex of surgeons and team composition and patients’ length of stay after surgery: evidence from inpatient claims data in China
Shen, C., Zhuang, Y., Alam, S. A.,
Zai, E.BMC Medicine, 1–31 (2026)
Abstract
Background: High-income country evidence suggests female physicians may achieve equal or better patient outcomes, but little is known about how surgeon sex and care-team gender composition affect postoperative recovery in low- and middle-income countries (LMICs). Hospital length of stay after surgery (LOSAS) is a key indicator of recovery efficiency and resource use. We assessed whether surgeon sex and team sex composition are associated with LOSAS in a large LMIC dataset.
Methods: We analyzed administrative data on 602,608 surgical inpatient admissions from all general hospitals in a western Chinese province (January–December 2023). Records were linked with workforce data to identify surgeon sex and team characteristics. Poisson models estimated associations between surgeon sex, team sex composition, and LOSAS, adjusting for patient- and surgeon-level factors, surgery-type and hospital-month fixed effects, enabling comparisons for identical procedures in the same hospital and month. Post-hoc analyses estimated predicted LOSAS in days.
Results: Within the sample, 48.4% (N = 363,659) of patients were female. Among the total surgeon population (N = 11,994), 58.7% (N = 7,042) were female. Patients treated by female surgeons had significantly shorter LOSAS relative to those treated by male surgeons in the overall sample (coefficient = -0.017; SE 0.008). These results remained robust across complex scenarios, including emergency department admissions and cases involving multiple surgeries within a single admission. Furthermore, procedures performed by female surgeons assisted by female first assistants had significantly shorter LOSAS (4.73 days) compared to male–male and female–male teams (5.04 days for both pairings). Younger female surgeons (born 1996–2005) had shorter LOSAS (4.50 days), relative to male counterparts (5.13 days).
Conclusions: In this LMIC setting, female surgeons are associated with shorter LOSAS, even when accounting for case complexity. However, team sex composition and generational differences are influential factors. Our findings suggest shorter LOSAS in female-led teams, specifically those with a female surgeon and a female first assistant, as well as among younger female cohorts. Supporting integration of female surgeons and providing opportunities for female-led teams may therefore enhance recovery efficiency. These results highlight the clinical value of increasing female representation in the surgical workforce.
Keywords: China, physicians, sex, surgery