Assessing racial disparities in gender-affirming surgery utilization and hospital-level experience

Racial and ethnic minority groups as well as gender minorities seeking gender-affirming care and surgery have historically had difficulties with healthcare access and experience. The intersection of these two groups may result in deficient healthcare for patients of minority racial and ethnic groups seeking gender-affirming surgery. This study sought to explore differences in gender-affirming genital surgery experience by race. The 2018-2021 Healthcare Utilization Project National Inpatient Survey was queried for gender-affirming surgeries. Demographic, inpatient safety, and hospital-level characteristics were collected. Results were stratified by race and evaluated for significant differences. A total of 4605 patients were included in the study, 3345 patients were identified as White (73%), 320 as Black/African American (7%), 485 as Hispanic/Latino (11%), and 110 as Asian/Pacific Islander (2%). Black/African American patients experienced a higher rate of inpatient medical complications than the overall population (1% vs. 3%, P = 0.004) and had a longer length of stay (3 vs. 5 days, P < 0.001). The highest total charges were observed among Black/African American patients ($130,873, IQR $119,235, P < 0.001). Black/African American patients also less often experienced routine discharge (94% vs. 81%, P < 0.001) and more often required a higher level of care upon discharge, such as home healthcare or transfer to another facility (6% vs. 17%, P < 0.001). While the healthcare population is becoming more diverse, healthcare disparities still exist among non-White individuals receiving gender-affirming genital surgery. The present data suggest that Black/African American patients receiving gender-affirming genital surgery have more complicated hospital and discharge courses, and experience higher total hospital charges.