Clinical Outcomes of Gender-Affirming Surgery in Individuals With Connective Tissue Disorders.

IF 1.4 4区 医学 Q3 SURGERY Annals of Plastic Surgery Pub Date : 2025-02-04 DOI:10.1097/SAP.0000000000004237
Jennifer K Shah, Justin M Camacho, Danielle Eble, Chandler Hinson, Daniel Najafali, Heli S Patel, Pin-Keng Shih, Rahim Nazerali, Shane D Morrison
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Abstract

Introduction: Gender-affirming surgery (GAS) is a complex process that often requires multiple surgical operations and carries a complication risk that could be exacerbated by connective tissue disorders (CTDs). This study aims to investigate the association between CTD diagnosis and GAS outcomes.

Methods: Using the Merative MarketScan Research Databases, patients with gender dysphoria diagnoses who underwent GAS between 2007 and 2022 were identified. Among these, patients with diagnosed CTDs were identified. Demographics, comorbidities, and postoperative complications were recorded. Chi-squared, Shapiro-Wilk, Wilcoxon-Mann-Whitney, and multivariate logistic regression testing was used for statistical analysis.

Results: Of 7575 patients meeting criteria (mean age 29 ±10 years), 300 (4%) had CTD diagnoses. One or more postoperative complications were recorded in 9.8% of patients, without statistically significant difference between CTD and non-CTD patients. Additional simultaneous GAS procedures [odds ratio (OR) 2.02; P < 0.01], Elixhauser index scores of 3+ (OR 1.36; P = 0.010), and age >45 years (OR 1.47; P = 0.02) increased odds of experiencing complications following the index GAS procedure, while CTD diagnoses (P = 0.52) did not affect odds of experiencing complications. However, CTD diagnoses did elevate odds of readmission (OR 1.47; P = 0.046), as did multiple simultaneous GAS procedures (OR 2.66), Elixhauser index scores of 3+ (OR 3.72), and smoking (OR 2.18) (P < 0.01).

Conclusions: These findings suggest CTDs may impact some gender-affirming surgical outcomes, and careful preoperative evaluation and management of comorbidities is necessary to reduce the risk of complications and readmission in this population. Surgeons should continue to exercise caution when performing elective surgery on patients taking immunomodulatory medications.

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结缔组织疾病患者接受性别确认手术的临床效果。
导言:性别确认手术(GAS)是一个复杂的过程,通常需要多次手术操作,并具有并发症风险,结缔组织疾病(CTD)可能会加剧这种风险。本研究旨在调查 CTD 诊断与 GAS 结果之间的关联:方法:使用 Merative MarketScan 研究数据库,对 2007 年至 2022 年期间接受 GAS 的性别障碍诊断患者进行识别。在这些患者中,确定了确诊的 CTD 患者。记录了人口统计学、合并症和术后并发症。统计分析采用了Chi-squared、Shapiro-Wilk、Wilcoxon-Mann-Whitney和多变量逻辑回归检验:在符合标准的 7575 名患者(平均年龄为 29 ± 10 岁)中,有 300 人(4%)被诊断为 CTD。9.8%的患者出现了一种或多种术后并发症,但CTD患者与非CTD患者之间的差异无统计学意义。其他同时进行的 GAS 手术[几率比 (OR) 2.02;P < 0.01]、Elixhauser 指数评分 3+(OR 1.36;P = 0.010)和年龄大于 45 岁(OR 1.47;P = 0.02)会增加指数 GAS 手术后出现并发症的几率,而 CTD 诊断(P = 0.52)不会影响出现并发症的几率。然而,CTD 诊断确实会增加再次入院的几率(OR 1.47;P = 0.046),同时进行多项 GAS 手术(OR 2.66)、Elixhauser 指数评分 3+ (OR 3.72)和吸烟(OR 2.18)也会增加再次入院的几率(P < 0.01):这些研究结果表明,CTD 可能会影响一些性别确认手术的结果,因此有必要对合并症进行仔细的术前评估和管理,以降低这类人群的并发症和再入院风险。外科医生在为服用免疫调节药物的患者实施择期手术时应继续保持谨慎。
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来源期刊
CiteScore
2.70
自引率
13.30%
发文量
584
审稿时长
6 months
期刊介绍: The only independent journal devoted to general plastic and reconstructive surgery, Annals of Plastic Surgery serves as a forum for current scientific and clinical advances in the field and a sounding board for ideas and perspectives on its future. The journal publishes peer-reviewed original articles, brief communications, case reports, and notes in all areas of interest to the practicing plastic surgeon. There are also historical and current reviews, descriptions of surgical technique, and lively editorials and letters to the editor.
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