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Race, Ethnicity, and Complications Following Gender-Affirming Surgery: A National Surgical Quality Improvement
Yu Jui Kung1, Bashar Hassan1, Calvin Schuster1
1Center for Transgender and Gender Expansive Health, Johns Hopkins University School of Medicine, Baltimore, USA.
Background:
Transgender and non-binary (TGNB) individuals face disproportionately limited access to gender-affirming surgery (GAS) due to systemic inequities. This study examines how these inequities, such as race and ethnicity, impact the utilization of GAS and associated surgical complications across different GAS subtypes.
Methods:
Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, we retrospectively reviewed TGNB individuals who underwent GAS from 2012 to 2021. The primary outcome was the incidence of major complications (e.g., unplanned reoperation and readmission) and minor complications (e.g., wound complications) within 30 days postoperatively. Bivariate and multivariable tests were used to compare the frequency of GAS and complications across racial and ethnic groups.
Results:
Among n = 6013 TGNB individuals, most were White (n = 3994, 66.4%), followed by Black (n = 880, 14.6%) and Hispanic (n = 788, 13.1%). Chest masculinization surgery was the most common procedure (n = 2395, 39.8%), followed by genital masculinization surgery (n = 1298, 21.6%), genital feminization surgery (n = 958, 15.9%), chest feminization surgery (n = 843, 14%), and facial feminization surgery (n = 396, 6.6%). White individuals were significantly more likely to undergo chest and genital masculinization surgery than Hispanic and Black individuals. Black individuals undergoing chest masculinization surgery had a higher frequency of unplanned reoperation (n = 14, 4.5%; n = 28, 1.7%; p = 0.042) and readmission (n = 7, 2.3%; n = 8, 0.5%; p = 0.048) compared with White individuals. For genital feminization surgery, Hispanic and Black individuals experienced significantly higher frequencies of wound disruption than White individuals (n = 12, 9.8%; n = 12, 8.7%; n = 21, 3.3%; p = 0.006). No significant disparities were observed for chest feminization, genital masculinization, or facial feminization surgeries.
Conclusion:
Racial and ethnic disparities exist in surgical utilization and complications among TGNB individuals, highlighting the need for additional research and possibly targeted interventions to address these inequities.
