Perioperative Estrogen Hormonal Therapy Does Not Increase Venous Thromboembolism Risk in Facial Feminization Surgery.

IF 3.2 2区 医学 Q1 SURGERY Plastic and reconstructive surgery Pub Date : 2024-12-01 Epub Date: 2024-04-02 DOI:10.1097/PRS.0000000000011437
Alexander Y Li, Matthew J Park, Jennifer Fick, Douglas K Ousterhout, Jordan C Deschamps-Braly
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Abstract

Background: Conflicting data exist regarding increased perioperative venous thromboembolism (VTE) risk with feminizing hormone therapy. The effect has been poorly studied within the transgender population. Acute perioperative cessation of feminizing hormone therapy often leads to unpleasant side effects and exacerbates gender dysphoria in the perioperative period. The authors sought to identify VTE incidence in patients undergoing facial feminization surgery while continuing hormone replacement therapy throughout the time of surgery.

Methods: A 38-year retrospective cohort study within a 2-surgeon practice (D.K.O. and J.C.D.-B.) was designed to evaluate postoperative VTE in patients continuing hormone therapy. The primary outcome variable was postoperative VTE.

Results: A total of 1715 patients underwent facial feminization surgery within our search window. A total of 953 patients met final inclusion criteria. One patient (0.10%) was diagnosed with a VTE postoperatively, comparable to reported literature rates for similar cosmetic and orthognathic procedures. The average Caprini score of all patients was 3.1 ± 1.0 and the average case length was 491.9 ± 111.0 minutes. Subgroup analysis of patients before and after internal practice changes identified 714 patients (77.7%) continuing full-dose hormonal therapy perioperatively, 197 (20.7%) undergoing hormonal dose reduction to 25% to 50% perioperatively, and 8 who were either not taking hormonal therapy or stopped in the perioperative period. There was no significant difference in VTE incidence among the 3 subgroups ( P > 0.99).

Conclusions: Perioperative use of feminizing hormonal therapy does not increase risk for perioperative VTE in patients undergoing facial feminization surgery. Therefore, it is reasonable to continue these medications through the time of surgery.

Clinical question/level of evidence: Therapeutic, III.

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面部女性化手术围手术期雌激素荷尔蒙疗法不会增加静脉血栓栓塞风险
背景:关于女性化激素治疗会增加围手术期 VTE 风险的数据存在冲突。对变性人群的影响研究较少。围手术期急性停止雌化激素治疗往往会导致令人不快的副作用,并加剧围手术期的性别焦虑症。我们试图确定接受面部女性化手术并在整个手术期间继续接受激素治疗的患者的 VTE 发生率:我们设计了一项由两名外科医生(D.K.O.和J.C.D.)进行的长达38年的回顾性队列研究,以评估继续接受激素治疗的患者的术后VTE情况。主要结果变量为术后发生 VTE:在我们的搜索窗口中,有 1715 名患者接受了面部女性化手术。953名患者符合最终纳入标准。1名患者(0.10%)在术后被诊断为VTE,与文献报道的类似美容和正颌手术的VTE发生率相当。所有患者的平均卡普里尼评分为(3.1±1.0)分,平均手术时间为(491.9±111.0)分钟。对内部做法改变前后的患者进行分组分析后发现,714 名患者(77.7%)在围手术期继续使用全剂量激素治疗,197 名患者(20.7%)在围手术期将激素剂量减少到 25%-50% ,还有 8 名患者在围手术期未使用或停止使用激素治疗。这三个亚组的 VTE 发生率没有明显差异(P > 0.99):结论:面部女性化手术患者围术期使用女性化激素治疗不会增加围术期 VTE 风险。因此,在手术期间继续使用这些药物是合理的。
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来源期刊
CiteScore
5.00
自引率
13.90%
发文量
1436
审稿时长
1.5 months
期刊介绍: For more than 70 years Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. Plastic and Reconstructive Surgery® , the official journal of the American Society of Plastic Surgeons, is a benefit of Society membership, and is also available on a subscription basis. Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, cosmetic surgery, as well as news on medicolegal issues. The cosmetic section provides expanded coverage on new procedures and techniques and offers more cosmetic-specific content than any other journal. All subscribers enjoy full access to the Journal''s website, which features broadcast quality videos of reconstructive and cosmetic procedures, podcasts, comprehensive article archives dating to 1946, and additional benefits offered by the newly-redesigned website.
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