Recognizing Racial Disparities in Postoperative Outcomes of Gender Affirming Surgery

Trilles, Jorge; Chaya, Bachar F.; Brydges, Hilliard T.; Parker, Augustus; Kimberly, Laura L.; Boczar, Daniel; Colon, Ricardo Rodriguez; Rodriguez, Eduardo D.

doi:10.1089/lgbt.2021.0396

Cited by 7 publications

(5 citation statements)

References 28 publications

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“…Although there is consistent evidence that racial disparities in surgical outcomes resolve whenever access becomes more equitable, our finding that White patients experience significantly fewer postoperative complications compared with other races, especially Black or African American patients, continues to highlight the need for further research on the systemic factors of health disparities in gender-affirming surgery. 27,28 These differences remain after adjustment for comorbidities like diabetes, being a smoker within the past year, and hypertension requiring medication, but factors like racial gaps in medical literature and surgeon trust are difficult to measure and compound through the intersectionality of race and gender affirmation.…”

Section: Discussionmentioning

confidence: 99%

Masculinizing Chest Reconstruction in Adolescents and Young Adults

Diaddigo,

Asadourian,

Lavalley

et al. 2024

Ann Plast Surg

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Background Masculinizing chest reconstruction (MCR) has been shown to improve quality of life and gender dysphoria in transmasculine adult patients. As nationwide access to gender-affirming care expands, more adolescents are seeking MCR. However, there is a paucity of literature examining patient characteristics, safety, and disparities among this population. Methods Cases of MCR were selected from the pediatric and adult American College of Surgeons and National Surgical Quality Improvement Program. Adolescent (18 years and older) and young adult (aged 19–25 years) transgender patients were analyzed for differences in demographics, comorbidities, surgical characteristics, and postoperative complications. Results A total of 1287 cases were identified, with an adolescent cohort of 189 patients. The proportion of White patients to other races was greater among adolescents than young adults (91.2% vs 82.4%, P = 0.007). Of adolescents and young adults, 6.0% and 11.1% identified as Hispanic/Latino, respectively (P = 0.059). Rates of all-cause postoperative complications were similar between adolescents (4.2%) and young adults (4.1%). Multivariate binary logistic regression showed that Black or African American patients experienced more all-cause postoperative complications than other races after controlling for American Society of Anesthesiologists classification, age group, and body mass index (odds ratio, 2.8; 95% confidence interval, 1.3–5.9; P = 0.008). Conclusions Masculinizing chest reconstruction is equally safe for transmasculine adolescent and young adult patients. However, our data point to racial disparities in access to care and postoperative outcomes. An intersectional approach is needed to better understand the unique health care needs and barriers to care of minority transgender youth.

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Section: Discussionmentioning

confidence: 99%

Masculinizing Chest Reconstruction in Adolescents and Young Adults

Diaddigo,

Asadourian,

Lavalley

et al. 2024

Ann Plast Surg

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“…To our knowledge, this is the first study to investigate relationships between diverse patient factors and long-term outcomes of breast augmentation in transgender patients. Although several studies have shown that there are racial disparities in postoperative outcomes of gender-affirming surgery, 17 , 18 including breast augmentation, 19 they only assess 30-day postoperative outcomes. Moreover, existing long-term studies on gender-affirming breast augmentation are primarily descriptive 12 , 14 and do not take into account racial/ethnic identity or socioeconomic status.…”

Section: Discussionmentioning

confidence: 99%

Evaluating Access and Outcomes in Gender-affirming Breast Augmentation: A Comparative Study of a County Hospital and an Academic Center

McLaughlin,

Rosser,

Song

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Background: Research on the diverse patient population undergoing gender-affirming breast augmentation remains scarce. We compared patients undergoing this procedure at San Francisco General Hospital (ZSFG), a county hospital, and the University of California, San Francisco (UCSF), an academic medical center. Methods: This was a retrospective cohort study of patients who underwent primary gender-affirming breast augmentation at ZSFG (August 2019 to June 2023) and UCSF (March 2015 to June 2023). Differences in sociodemographic characteristics, surgical access, and outcomes between sites were assessed. Results: Of 195 patients, 122 patients had surgery at UCSF and 73 patients at ZSFG. ZSFG patients were more likely to be unstably housed (P < 0.001), Spanish-speaking (P = 0.001), and to have obesity (P = 0.011) and HIV (P = 0.004). Patients at ZSFG took hormones for longer before surgical consultation (P < 0.001) but had shorter referral-to-surgery intervals (P = 0.024). Patients at ZSFG more frequently underwent a subglandular approach (P = 0.003) with longer operative times (P < 0.001). Major surgical complications were uncommon (2.1%) with no differences between sites. Aesthetically, implant malposition/rotation occurred more often in patients at UCSF (P = 0.031), but revision rates were similar at both sites. Patients at UCSF had longer follow-up periods (P = 0.008). Conclusions: County hospital patients seeking gender-affirming breast augmentation have distinct sociodemographic profiles and more comorbidities than academic medical center patients. County patients might experience greater barriers that delay surgical eligibility, such as stable housing. Nevertheless, this procedure can be safely and effectively performed in both patient populations.

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“…Although our study was not powered to detect individual racial differences, differences in race bring in larger questions of surgical access and are an area for further exploration and research. A separate study of TGNB patients in the ACS NSQIP database demonstrated that race is an independent predictor of postoperative outcomes after gender-affirming surgical procedures, with Black patients having higher odds of reoperation 30 …”

Section: Discussionmentioning

confidence: 99%

“…A separate study of TGNB patients in the ACS NSQIP database demonstrated that race is an independent predictor of postoperative outcomes after gender-affirming surgical procedures, with Black patients having higher odds of reoperation. 30 Strengths of this study include its use of a large, national database designed to track surgical outcomes. Our study should be interpreted in the context of several limitations.…”

Section: Discussionmentioning

confidence: 99%

Complications After Orchiectomy and Vaginoplasty for Gender Affirmation: An Analysis of Concurrent Versus Separate Procedures Using a National Database

Russell¹,

Hong²,

Fairchild³

et al. 2023

UROGC

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Importance Gender-affirming orchiectomy may be performed in isolation, as a bridge to vaginoplasty, or concurrently with vaginoplasty for transgender and nonbinary persons, although there is a paucity of data on immediate postoperative outcomes on the various procedural approaches.Objective The aim of the study is to compare 30-day surgical outcomes after gender-affirming orchiectomy and vaginoplasty as separate and isolated procedures. Study Design This was a retrospective cohort study of patients in the American College of Surgeons National Surgical Quality Improvement Program database to compare surgical outcomes of orchiectomy alone and vaginoplasty alone to concurrent orchiectomy with vaginoplasty using bivariate and adjusted multivariable regression statistics. Results Concurrent orchiectomy and vaginoplasty were associated with greater 30-day surgical complications compared with orchiectomy alone (15.4% vs 2.9%, P < 0.01) and similar odds of 30-day surgical complications compared with vaginoplasty alone (15.4% vs 11.1%, P = 0.15). On multivariable logistic regression analysis, compared with orchiectomy alone, concurrent orchiectomy and vaginoplasty were associated with higher increased odds of 30-day surgical complications (adjusted odds ratio, 6.48; 95% confidence interval, 2.83-14.86) as well as vaginoplasty alone (adjusted odds ratio 4.30; 95% confidence interval, 1.85-10.00). Conclusions This study highlights the perioperative outcomes for isolated versus concurrent gender-affirming orchiectomy and vaginoplasty, demonstrating lower morbidity for orchiectomy alone and similar morbidity for vaginoplasty alone when compared with concurrent procedures. These data will aid health care providers in preoperative counseling and surgical planning for gender-affirming genital surgery, particularly for patients considering concurrent versus staged orchiectomy and vaginoplasty.

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Recognizing Racial Disparities in Postoperative Outcomes of Gender Affirming Surgery

Cited by 7 publications

References 28 publications

Masculinizing Chest Reconstruction in Adolescents and Young Adults

Masculinizing Chest Reconstruction in Adolescents and Young Adults

Evaluating Access and Outcomes in Gender-affirming Breast Augmentation: A Comparative Study of a County Hospital and an Academic Center

Complications After Orchiectomy and Vaginoplasty for Gender Affirmation: An Analysis of Concurrent Versus Separate Procedures Using a National Database

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