Gender-Affirming Surgeries

Abstract

Background Gender affirmation surgery is an exponentially growing field within plastic surgery. The aim of our study is to analyze demographics, procedure type, trends, and outcomes in the surgical management of gender identity disorder in the past few years. Methods The American College of Surgeons NSQIP database was queried for the years 2015 to 2019. International Classification of Diseases codes were used to identify all gender-affirming cases. Patients were categorized by procedure type using Current Procedural Terminology codes for feminizing/masculinizing top, bottom and head/neck procedures. Patient demographics, comorbidities, and postoperative complications were analyzed using SPSS statistics software. A comparative analysis was performed among the procedure type. Results From 2015 to 2019, 4114 patients underwent a gender-affirming surgery (GAS) increasing the number of surgeries by over 400%, according to the NSQIP database. Demographics include age (mean = 32 years), body mass index (mean = 28 kg/m2), race (60% White, 22% unknown, 13% African American, 4% Asian, 1% other). Female to male procedures represented the most commonly performed (n = 2647; 64%), followed by male to female (n = 1278; 31%) with head/neck procedures representing 5% (n = 189) of all procedures. Top surgeries were also the most common (n = 2347, 57%), followed by bottom surgeries (n = 1578, 38%). The overall complication rate was 6% (n = 247), 2.1% (n = 4) for head/neck procedures, 8% (n = 134) for bottom procedures, and 3.5% (n = 84) for top surgeries. A reoperation within 30 days and related to the initial GAS occurred for 52 patients. Postoperative complication rates were statistically different between bottom surgeries compared with the top and head/neck procedure groups (P < 0.001). Increasing age and body mass index showed a significantly higher odds of having a complication. Conclusions Gender-affirming procedures have significantly increased over the past 5 years. Increased exposure through literature and research, as well as an improvement in social climates, including increasing insurance coverage have contributed to the expansion of these procedures. Low serious complication rates within 30 days prove GAS to be safe.

Impact of Medicaid Expansion on Genital Gender-Affirming Surgery in New York State

“…These findings are consistent with 2 previous population-based studies which report significant growth in GAS over the last 20 years, though those studies lack granularity to report on incidence of specific procedures. 2,3 The marked rise seen in our study may reflect a build-up of demand prior to Medicaid expansion in NYS. Nationwide, one study querying GAS from 2000 to 2014 found that the number of patients covered by Medicaid or Medicare increased threefold from 2012-2013 to 2014.…”

“…Using the NYS HCUP (Healthcare Cost and Utilization Project) State Inpatient Database from 2008 to 2017, we identified all adult patients ≥18 years old with an ICD-9/10 diagnosis of gender dysphoria using a previously described method for identifying transgender individuals in claims data (Supplementary Appendix, https://www.urologypracticejournal.com). 2,3,7,8 Of those, we identified patients who underwent genital GAS—phalloplasty or vaginoplasty—using ICD-9/10 procedure codes (Supplementary Appendix, https://www.urologypracticejournal.com).…”

“…Approximately 1.6 million people identify as transgender in the United States. 1 Studies suggest a growing number of individuals undergo gender-affirming surgery (GAS), 2,3 a core component of transgender care which can alleviate distress associated with gender dysphoria and help align self-identified gender with physical appearance and function. Nonetheless, major barriers for accessing GAS persist, including lack of appropriate insurance coverage.…”

Multidimensional Assessment of Patient-Reported Outcomes After Gender-Affirming Surgeries Using a Validated Instrument

“…This might be due to prolonged recovery time and higher complication rates in genital surgeries. 3,13,[20][21][22] Studies have shown that level of independence was significantly worse after GAS, which might lead to worse satisfaction scores for patients who underwent genital surgeries. 23 Our study showed that non-White patients had higher VMP-G scores before and after GAS, compared with White patients.…”

“…Interestingly, patients who underwent chest surgeries reported higher scores in satisfaction domain (20.4 vs 18.4, P = 0.02). This might be due to prolonged recovery time and higher complication rates in genital surgeries 3,13,20–22 . Studies have shown that level of independence was significantly worse after GAS, which might lead to worse satisfaction scores for patients who underwent genital surgeries 23 .…”