Introduction: Sexism and bias against female surgeons exist today and can impede patient care. This study examines discrepancies in decision-to-incision time (DIT) for male and female surgeons performing emergent operations. Methods: A retrospective chart review of emergent and trauma cases was conducted at a Level I trauma center between August 2015 and October 2019. DIT was calculated from case posting time to incision time. Additional variables included indication, patient gender and age, time of day, surgeon gender and experience, and gender of assisting staff in the operating room. Poisson regression model with random effects for 10 unique surgery indications and surgeon identification was performed. Results: A total of 1,226 emergent general surgery or trauma cases were included for analysis. DIT did not vary significantly between male and female surgeons (80.38 vs 70.72 minutes; p = 0.50). After controlling for other factors, female surgeons operating with a majority female staff (both female) had a DIT that was 1.08 times longer than with a majority male staff (p < 0.01) (Figure). On average, female surgeons with majority male staff had a DIT of 59.19 minutes and female surgeons with majority female staff had a DIT of 85.49 minutes. Male surgeon DIT did not vary with staff gender. [Formula presented] Conclusions: Female surgeons who operate with predominantly female staff in emergency settings have a prolonged DIT, leading to critical delays in patient care. Efforts to identify and correct implicit bias against female surgeons are key to ensuring excellent patient outcomes and requires collaborative engagement by all team members.

Studies of adults with schizophrenia provide converging evidence for abnormalities in the limbic system. Limbic structures that show consistent patient/control differences in both postmortem and neuroimaging studies include the anterior cingulate and hippocampus, although differences in the amygdala, parahippocampal gyrus, and fornix have also been observed. Studies of white matter in children and adolescents with schizophrenia tend to show findings that are more focal than those seen in adults. Interestingly, these focal abnormalities in early-onset schizophrenia tend to be more localized to limbic regions. While it is unclear if these early limbic abnormalities are primary in the etiology of schizophrenia, there is evidence that supports a developmental progression with early limbic abnormalities evolving over time to match the neuroimaging profiles seen in adults with schizophrenia. Alternatively, the aberrations in limbic structures may be secondary to a more widespread or global pathological processes occurring with the brain that disrupt neural transmission. The goal of this article is to provide a review of the limbic system and limbic network abnormalities reported in children and adolescents with schizophrenia. These findings are compared with the adult literature and placed within a developmental context. These observations from neuroimaging studies enrich our current understanding of the neurodevelopmental model of schizophrenia and raise further questions about primary vs secondary processes. Additional research within a developmental framework is necessary to determine the putative etiologic roles for limbic and other brain abnormalities in early-onset schizophrenia.