University of Michigan Medical School, Ann Arbor.
Section of Plastic Surgery, University of Michigan, Ann Arbor.
JAMA Surg. 2023 Oct 1;158(10):1070-1077. doi: 10.1001/jamasurg.2023.3352.
There has been increasing legislative interest in regulating gender-affirming surgery, in part due to the concern about decisional regret. The regret rate following gender-affirming surgery is thought to be approximately 1%; however, previous studies relied heavily on ad hoc instruments.
To evaluate long-term decisional regret and satisfaction with decision using validated instruments following gender-affirming mastectomy.
DESIGN, SETTING, AND PARTICIPANTS: For this cross-sectional study, a survey of patient-reported outcomes was sent between February 1 and July 31, 2022, to patients who had undergone gender-affirming mastectomy at a US tertiary referral center between January 1, 1990, and February 29, 2020.
Decisional regret and satisfaction with decision to undergo gender-affirming mastectomy.
Long-term patient-reported outcomes, including the Holmes-Rovner Satisfaction With Decision scale, the Decision Regret Scale, and demographic characteristics, were collected. Additional information was collected via medical record review. Descriptive statistics and univariable analysis using Fisher exact and Wilcoxon rank sum tests were performed to compare responders and nonresponders.
A total of 235 patients were deemed eligible for the study, and 139 responded (59.1% response rate). Median age at the time of surgery was 27.1 (IQR, 23.0-33.4) years for responders and 26.4 (IQR, 23.1-32.7) years for nonresponders. Nonresponders (n = 96) had a longer postoperative follow-up period than responders (median follow-up, 4.6 [IQR, 3.1-8.6] vs 3.6 [IQR, 2.7-5.3] years, respectively; P = .002). Nonresponders vs responders also had lower rates of depression (42 [44%] vs 94 [68%]; P < .001) and anxiety (42 [44%] vs 97 [70%]; P < .001). No responders or nonresponders requested or underwent a reversal procedure. The median Satisfaction With Decision Scale score was 5.0 (IQR, 5.0-5.0) on a 5-point scale, with higher scores noting higher satisfaction. The median Decision Regret Scale score was 0.0 (IQR, 0.0-0.0) on a 100-point scale, with lower scores noting lower levels of regret. A univariable regression analysis could not be performed to identify characteristics associated with low satisfaction with decision or high decisional regret due to the lack of variation in these responses.
In this cross-sectional survey study, the results of validated survey instruments indicated low rates of decisional regret and high levels of satisfaction with decision following gender-affirming mastectomy. The lack of dissatisfaction and regret impeded the ability to perform a more complex statistical analysis, highlighting the need for condition-specific instruments to assess decisional regret and satisfaction with decision following gender-affirming surgery.
由于对决策后悔的担忧，立法者对规范性别肯定手术的兴趣日益增加。据认为，性别肯定手术后的后悔率约为 1%；然而，以前的研究主要依赖于特定的工具。
使用经过验证的工具评估性别肯定乳房切除术（gender-affirming mastectomy）后长期的决策后悔和对决策的满意度。
设计、设置和参与者：在这项横断面研究中，于 2022 年 2 月 1 日至 7 月 31 日之间，向美国一家三级转诊中心在 1990 年 1 月 1 日至 2020 年 2 月 29 日期间接受过性别肯定乳房切除术的患者发送了一份患者报告结果调查。
接受性别肯定乳房切除术的决策后悔和对决策的满意度。
收集了长期的患者报告结果，包括 Holmes-Rovner 决策满意度量表、决策后悔量表以及人口统计学特征。通过病历回顾收集了其他信息。使用 Fisher 确切检验和 Wilcoxon 秩和检验进行描述性统计和单变量分析，以比较应答者和非应答者。
共有 235 名患者被认为符合研究条件，其中 139 名患者做出了回应（59.1%的回应率）。应答者的手术时中位年龄为 27.1（IQR，23.0-33.4）岁，而非应答者为 26.4（IQR，23.1-32.7）岁。非应答者（n=96）的术后随访时间长于应答者（中位数随访时间，4.6[IQR，3.1-8.6]与 3.6[IQR，2.7-5.3]年，分别；P=0.002）。与应答者相比，非应答者的抑郁发生率较低（42[44%]与 94[68%]；P<0.001），焦虑发生率也较低（42[44%]与 97[70%]；P<0.001）。没有应答者或非应答者要求或进行了逆转手术。满意度量表的中位数评分为 5.0（IQR，5.0-5.0），分数越高表示满意度越高。决策后悔量表的中位数评分为 0.0（IQR，0.0-0.0），分数越低表示后悔程度越低。由于这些反应缺乏变化，无法进行单变量回归分析来确定与低决策满意度或高决策后悔相关的特征。
在这项横断面调查研究中，经过验证的调查工具的结果表明，性别肯定乳房切除术后的决策后悔率较低，对决策的满意度较高。缺乏不满和后悔阻碍了对更复杂的统计分析的能力，突出了需要特定于病情的工具来评估性别肯定手术后的决策后悔和对决策的满意度。
