Aquino Nelson J, Boskey Elizabeth R, Staffa Steven J, Ganor Oren, Crest Alyson W, Gemmill Kristin V, Cravero Joseph P, Vlassakova Bistra
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA 02115, USA.
Center for Gender Surgery, Boston Children's Hospital, Boston, MA 02115, USA.
J Clin Med. 2022 Mar 31;11(7):1943. doi: 10.3390/jcm11071943.
Most minors and young transgender persons wishing to undergo gender-affirming surgery need to seek specialists affiliated with gender affirmation programs in adult hospitals. Research suggests gender affirmation surgery has been established as an effective and medically indicated treatment for gender dysphoria. Although most data on gender-affirming surgeries are from adult populations, there is growing literature establishing their effectiveness in adolescents and young adults. Therefore, it is critical to evaluate the perioperative outcomes for gender-diverse youth to deliver safe and affirming care. The primary objective of this retrospective case series is to examine the perioperative characteristics and outcomes of patients with gender identity disorders (International Classification of Diseases [ICD]-10-code F64) who underwent chest reconstruction (mastectomy) and genital surgery (phalloplasty, metoidioplasty, and vaginoplasty) in a pediatric academic hospital. The secondary aim is to evaluate the value of a specialized anesthesia team for improving clinical outcomes, interdisciplinary communication, and further advancing the transgender perioperative experience. We identified 204 gender affirmation surgical cases, 177 chests/top surgeries, and 27 genital/bottom surgeries. These findings indicate gender-diverse individuals who underwent life-changing surgery at our institution had a median age of 18 years old, with many patients identifying as transmen. Our data suggests that postoperative pain was significant, but adverse events were minimal. The evolution of a specialty anesthesia team and initiatives (anesthesia management guidelines, scheduling, continuity, and education) necessitate direct care coordination and multidisciplinary planning for gender affirmation surgery in transgender youth.
大多数希望接受性别肯定手术的未成年人和年轻跨性别者需要寻求成年医院中与性别肯定项目相关的专家。研究表明，性别肯定手术已被确立为一种治疗性别焦虑症的有效且有医学指征的疗法。尽管大多数关于性别肯定手术的数据来自成年人群，但越来越多的文献证实了其在青少年和年轻成年人中的有效性。因此，评估性别多样化青少年的围手术期结果对于提供安全且肯定性的护理至关重要。本回顾性病例系列的主要目的是研究在一家儿科教学医院接受胸部重建（乳房切除术）和生殖器手术（阴茎成形术、阴囊阴茎成形术和阴道成形术）的性别认同障碍患者（国际疾病分类[ICD]-10编码F64）的围手术期特征和结果。次要目的是评估专业麻醉团队对于改善临床结果、跨学科沟通以及进一步提升跨性别者围手术期体验的价值。我们确定了204例性别肯定手术病例，其中177例为胸部/上半身手术，27例为生殖器/下半身手术。这些发现表明，在我们机构接受改变人生手术的性别多样化个体的中位年龄为18岁，许多患者认定自己为跨性别男性。我们的数据表明术后疼痛较为显著，但不良事件极少。专业麻醉团队及其举措（麻醉管理指南、排班、连续性和教育）的发展需要对跨性别青少年的性别肯定手术进行直接护理协调和多学科规划。
