Yusuke Tsugawa

Some prior studies have found that patients treated by female physicians may experience better outcomes, as well as lower health care costs than those treated by male physicians. Physician-patient sex concordance may also contribute to better patient outcomes. However, other studies have not identified a significant difference. There is a paucity of pooled evidence examining the association of physician sex with clinical outcomes.

This random-effects meta-analysis was conducted according to the PRISMA guidelines and prospectively registered on PROSPERO. MEDLINE and EMBASE were searched from inception to October 4, 2023, and supplemented by a hand-search of relevant studies. Observational studies enrolling adults (≥ 18 years of age) and assessing the effect of physician sex across surgical and medical specialties were included. The risk of bias was assessed using ROBINS-I. A priori subgroup analysis was conducted based on patient type (surgical versus medical). All-cause mortality was the primary outcome. Secondary outcomes included complications, hospital readmission, and length of stay.

Findings: Across 35 (n = 13,404,840) observational studies, 20 (n = 8,915,504) assessed the effect of surgeon sex while the remaining 15 (n = 4,489,336) focused on physician sex in medical/anesthesia care. Fifteen studies were rated as having a moderate risk of bias, with 15 as severe, and 5 as critical. Mortality was significantly lower among patients of female versus male physicians, which remained consistent among surgeon and non-surgeon physicians. No significant evidence of publication bias was detected. There was significantly lower hospital readmission among patients receiving medical/anesthesia care from female physicians. In a qualitative synthesis of 9 studies (n = 7,163,775), patient-physician sex concordance was typically associated with better outcomes, especially among female patients of female physicians.

Patients treated by female physicians experienced significantly lower odds of mortality, along with fewer hospital readmissions, versus those with male physicians. Further work is necessary to examine these effects in other care contexts across different countries and understand underlying mechanisms and long-term outcomes to optimize health outcomes for all patients.
 

Prior research demonstrates that local government spending on social policies, excluding health care, is linked to improved population health. Whether such spending is associated with better access to primary care and reduced acute care utilization remains unclear.

In this study, authors evaluated the associations between county-level social spending and individual-level health care utilization among low-income Medicare beneficiaries, aged ≥65 years, from 2016 to 2018. Authors linked claims data to 4 categories of county-level government expenditures from the U.S. Government Finance Database, including (1) public welfare, (2) public transit, (3) housing/community development, and (4) infrastructure-related social services. The main outcomes were annual primary care visit rates, emergency department visits, and preventable hospitalizations.

Findings: After adjusting for patient and county characteristics, beneficiaries living in counties with higher spending on housing/community development had 11% higher primary care visit rates. Additionally, those living in counties with higher public transit and housing/community development spending experienced 6%–10% lower preventable hospitalization rates. Lower preventable hospitalization rates were especially pronounced among acute conditions.

These findings suggest that investments in social services that address the health-related social needs of low-income older adults may be an important factor to consider in population-level efforts to reduce acute care utilization.
 

Evidence is limited as to whether outcomes differ between patients with tricuspid regurgitation (TR) treated with tricuspid transcatheter edge-to-edge repair (T-TEER) versus surgical tricuspid valve repair. Authors aimed to compare outcomes between these two approaches. They analyzed the data on Medicare fee-for-service beneficiaries aged 65 to 99 years with TR who underwent T-TEER or isolated surgical repair between July 2016 and December 2020. The primary outcome was 2-year all-cause mortality. Other outcomes included in-hospital mortality and permanent pacemaker implantation as well as 2-year heart failure hospitalization and tricuspid valve reintervention.

Findings: A total of 1,143 patients were included (409 T-TEER versus 734 surgery). The proportion of T-TEER cases increased from 2% in the third quarter of 2016 to 67% in the last quarter of 2020 among all isolated TR procedures. Researchers found no evidence that 2-year all-cause mortality differs between patients treated with T-TEER versus surgical repair. Patients treated with T-TEER experienced lower in-hospital mortality and permanent pacemaker implantation rates than those treated by surgical repair. At 2 years, researchers found no differences in heart failure hospitalizations, but tricuspid valve reinterventions were more frequent in the T-TEER group.

Among Medicare beneficiaries with TR, the 2-year mortality rate was comparable between T-TEER and surgical repair. T-TEER showed advantages in perioperative outcomes, including lower in-hospital mortality and pacemaker implantation rates, whereas tricuspid valve reinterventions were more frequent in the T-TEER group. Further studies are necessary to refine indications, patient selections, and optimal timing for intervention with either treatment strategy.
 

There are two degree programs for licensed physicians in the U.S.: allopathic medical doctorate (MD) and osteopathic doctorate (DO). However, evidence is limited as to whether outcomes differ between patients treated by MD vs DO surgeons.

Researchers evaluate differences in surgical outcomes and practice patterns by surgeon medical school training (MD vs DO). This study used 100% Medicare claims data from inpatient hospitals providing surgical services from January 1, 2016, to December 31, 2019 among Medicare fee-for-service beneficiaries aged 65 to 99 years who underwent 1 of the 14 most common surgical procedures. Data analysis was performed from January 17, 2023, to August 13, 2024.

The primary outcome was 30-day mortality, and the secondary outcomes were readmissions and length of stay. To assess differences between surgeons by medical school training, a multivariable linear probability model was used, which was adjusted for hospital fixed effects and patient, procedure, and surgeon characteristics.

Findings: Of the 2,360,108 total surgical procedures analyzed, 2,154,562 (91.3%) were performed by MD surgeons, and 205,546 (8.7%) were performed by DO surgeons. Of 43,651 total surgeons, most surgeons were MDs (39,339 or 90.1%), the median age was 49.0 years, and 6,649 surgeons (15.2%) were female. The mean age of patients undergoing surgical procedures was 74.9 years, 1, 353,818 of 2,360,108 patients (57.4%) were female, and 2,110,611 patients (89.4%) self-reported as white.

DO surgeons were significantly more likely to operate on older patients, female patients, and Medicaid dual-eligible patients. DOs performed a lower proportion of elective operations and were more likely to work in public hospitals and nonteaching hospitals. There was no evidence that 30-day mortality differed between MD and DO surgeons. On secondary analyses, no difference was found in 30-day readmissions or length of stay between MD and DO surgeons.

In this retrospective cohort study using Medicare data, there was no evidence that patient outcomes differed between MD and DO surgeons for common operations after adjusting for patient factors and practice settings.