Young Adult and Adolescent Gender-affirming Care: Defining Perioperative Protocols

Adolescents and young adults who undergo gender-affirming care require special consideration in the postoperative period. This study evaluated pain management and perioperative details during our clinic's transition to outpatient gender-affirming mastectomy (GAM).

This was a retrospective review of demographic and perioperative data for individuals who underwent GAM at a single institution from 2019 to 2022. Patients were grouped by the timing of surgery: before ("preprotocol," n = 25) or after ("postprotocol," n = 45) implementation of the outpatient protocol. Multivariate linear and logistic regression and independent t tests were used.

There were 70 patients with a mean age of 19.3 years (SD = 1.75 y). Patients who received an erector spinae plane nerve block before the procedure received fewer morphine milligram equivalents postoperatively compared with those who received a postincision erector spinae plane nerve block (P = 0.006). There was a trend in association such that patients who had liposuction received fewer morphine milligram equivalents (P = 0.09). The average hospital stay for the postprotocol group was shorter compared with the preprotocol group (P < 0.001). At discharge, 28% of preprotocol patients were prescribed opioids compared with 9% of postprotocol patients. There was no difference in minor complications between the cohorts. One patient experienced a major complication, which was treated nonoperatively.

Our findings highlight the successful implementation of outpatient GAM for young adults at a children's hospital. The new protocol yielded a shorter duration of hospital stay and less frequent postoperative opioid prescriptions without impacting the incidence of complications.