Women in Surgery Italia: what are the opportunities in the operatory room? Results from a nationwide interdisciplinary survey.

Many studies documented the "glass ceiling" effect for women in surgery: achievements in academic and leadership positions are not consistent with the percentage of female surgeons in practice. A solid surgical case volume and expertise in high-complexity cases are required to pursue leadership positions. The aim of the study was to determine whether part of the difficulties encountered by female surgeons may lie in reduced surgical opportunities. This is the first study to investigate this issue in Italy. An online survey, conceived and promoted by Women in Surgery Italia, was administered through the RedCap platform, between November and December 2020, and female surgeons actively working in Italian academic and non-academic hospitals were invited to answer anonymously. A multivariate analysis was performed to evaluate the role of different factors on two main variables: overall procedures done and a sub-analysis of complex cases performed as first surgeon. 1810 respondents were included; the women who responded participated in 3% fewer cases on average, when compared to the mean staff case volume, and were significantly more often listed as the assistant surgeon and as primary surgeons in low-complexity cases. 36.5% of the respondents declared that at least one female physician on staff had to abandon the operatory room (OR) and does not regularly perform any surgical procedure. 73% female surgeons would like to spend more hours in the OR. While acquiring skills and surgical autonomy, many obstacles still exist for female surgeons. A portion of women are relegated to non-surgical activities, irrespective of their specialty, and these results confirm the theory that gender-biased underemployment still exists in surgical fields.