Odds for reoperation, readmission after gender-affirming surgery higher for Black patients
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Black adults undergoing gender-affirming surgery have higher odds for reoperation, 30-day readmission and organ/space surgical site infection than white patients, according to study data published in LGBT Health.
“We found that race was an independent predictor of important short-term postoperative outcomes in gender-affirming surgery,” Eduardo D. Rodriguez, MD, DDS, a plastic surgeon at NYU Langone Health, and colleagues wrote. “These disparities may stem from patient, provider and systemic factors. Inclusive clinical research, effective engagement with the transgender and gender-expansive community, and surgery-specific enhanced recovery after surgery protocols may help address disparities at the patient and provider levels.”
Researchers conducted a retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database from 2010 to 2018. There were 2,308 people with a primary diagnosis of gender dysphoria undergoing gender-affirming surgery included in the analysis. Demographic information and surgery type were collected. Researchers collected 30-day postoperative outcomes, including wound dehiscence, superficial surgical site infection, bleeding requiring transfusion, deep vein thrombosis, pulmonary embolism, pneumonia, urinary tract infection, sepsis, reoperation related to the primary procedure and readmission.
Of the study cohort, 77.1% were white, 18.1% were Black and 4.7% were Asian. After adjusting for gender, BMI, smoking status, type of surgery performed and hypertension, Black patients were more likely to need a reoperation (adjusted OR = 1.82; 95% CI, 1-3.29; P = .047), be readmitted to the hospital (aOR = 2.46; 95% CI, 1.35-4.47; P = .003) and develop an organ/space surgical site infection (aOR = 4.65; 95% CI, 1.22-17.67; P = .024) compared with white patients. There were no differences in postoperative outcomes between white and Asian patients.
No confounders in the study were independent predictors for organ/space surgical site infection or reoperation. However, masculinizing bottom surgery excluding hysterectomy (OR = 6.94; 95% CI, 2.47-19.45; P < .001) and feminizing bottom surgery (OR = 2.91; 95% CI, 1.37-6.19; P = .006) were associated with an increased likelihood for 30-day hospital readmission.
“Further studies are needed to corroborate our findings and explore evidence-based strategies to eliminate any racial disparities in gender-affirming surgery,” the researchers wrote. “We encourage large single- and multicenter studies with long-term outcomes stratified by race/ ethnicity and surgical technique so that we may build a better foundation of knowledge in the literature.”
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