Trends in Patient-Surgeon Sex Concordance and Surgical Volume in Cataract Surgery: A 14-Year Retrospective Cohort Study

PURPOSE: To characterize patient-surgeon sex concordance and evaluate sex-based trends in cataract surgical volume over a 14-year period. DESIGN: Retrospective cohort and trend study. SUBJECTS: All cataract surgeries performed and all surgeons performing cataract surgery at the Bascom Palmer Eye Institute between January 1, 2011, and November 7, 2024. METHODS: Cataract surgery counts were aggregated by surgeon sex, patient sex, and calendar year to assess patient-surgeon sex concordance and longitudinal trends in surgical volume. Surgeon workforce composition and annual surgical productivity were evaluated using procedure counts. Associations between surgeon sex, sex distribution of operated eyes, and changes in surgical volume over time were examined. MAIN OUTCOME MEASURES: Primary outcomes were patient-surgeon sex concordance at the cataract surgery level and surgeon-level cataract surgery volume. Secondary outcomes included temporal trends in surgeon workforce composition and sex-stratified distributions of cataract surgeries. RESULTS: Among 88,420 cataract surgeries (mean age of 68.2 ± 11.1 years; 55.9% female patients; 122 surgeons), women comprised approximately one-third of active surgeons, a proportion that remained stable over time. Patient-surgeon sex concordance was modest (OR, 1.06; 95% CI, 1.03-1.09), indicating limited deviation from equal odds of same-sex pairing. Despite stable workforce representation, female surgeons' share of institutional cataract volume increased from 37.8% in 2011 to 52.8% in 2024 (β = 10.8 cases/year; P < .001), with higher mean annual productivity per surgeon in 2023-2024 compared with male surgeons (249.2 vs 122.7 cases; P = .03). Female surgeon productivity was strongly correlated with patient-surgeon sex concordance over time (ρ=0.83; P < .001). CONCLUSIONS: In this large longitudinal cohort, patient-surgeon sex concordance was modest and closely aligned with changes in surgeon productivity and workforce output. These findings suggest that sex-based productivity disparities are modifiable and that institutional factors related to surgical volume distribution may influence gender equity in ophthalmic surgical practice.