Division of Plastic and Reconstructive Surgery, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, United States.
T.H. Chan School of Public Health, Harvard University, Boston, MA, United States.
J Plast Reconstr Aesthet Surg. 2023 Oct;85:393-400. doi: 10.1016/j.bjps.2023.07.044. Epub 2023 Jul 23.
Prescription drug misuse in transgender individuals is estimated to be three times higher than that of the general population in the United States, suggesting that opioid-reduction strategies deserve significant consideration in gender-affirming surgeries. In this work, we describe the implementation of an enhanced recovery after surgery (ERAS) protocol to reduce opioid use after facial feminization surgery.
A total of 79 patients who underwent single-stage facial feminization surgery before (n = 38) or after (n = 41) ERAS protocol implementation were included. Primary outcomes assessed were perioperative opioid consumption (morphine equivalent dose/kilogram, MED/kg), average patient-reported pain scores, and length of hospital stay. Comparisons between groups and multivariable linear regression analyses were conducted to define the contribution of the ERAS protocol to each of the three primary outcomes.
Age, body mass index, mental health diagnoses, and length of surgery did not differ between pre-ERAS and ERAS groups. Compared to pre-ERAS patients, patients treated under the ERAS protocol consumed less opioids (median [interquartile range, IQR], 0.8 [0.5-1.1] versus 1.5 [1.0-2.1] MED/kg, p < 0.001), reported lower pain scores (2.5 ± 1.8 versus 3.7 ± 1.6, p = 0.002), and required a shorter hospital stay (median [IQR], 27.3 [26.3-49.8] versus 32.4 [24.8-39.1] h, p < 0.001). When controlling for other contributing variables such as previous gender-affirming surgeries, mental health diagnoses, and length of surgery using multivariable linear regression analyses, ERAS protocol implementation independently predicted reduced opioid use, lower pain scores, and shorter hospital stay after facial feminization surgery.
The current work details an ERAS protocol for facial feminization surgery that reduces perioperative opioid consumption, patient-reported pain scores, and hospital stays.
据估计，美国跨性别者的处方药物滥用是普通人群的三倍，这表明在性别肯定手术中，应该考虑减少阿片类药物的策略。在这项工作中，我们描述了实施增强手术后康复（ERAS）方案以减少面部女性化手术后阿片类药物使用的情况。
共纳入 79 例接受单阶段面部女性化手术的患者，其中术前（n=38）或术后（n=41）实施 ERAS 方案。主要评估的结果是围手术期阿片类药物的使用量（吗啡等效剂量/公斤，MED/kg）、患者平均报告的疼痛评分和住院时间。进行组间比较和多变量线性回归分析，以确定 ERAS 方案对三个主要结果中的每一个的贡献。
年龄、体重指数、心理健康诊断和手术时间在 ERAS 前后组之间没有差异。与 ERAS 前患者相比，接受 ERAS 方案治疗的患者使用的阿片类药物较少（中位数[四分位距，IQR]，0.8 [0.5-1.1] 与 1.5 [1.0-2.1] MED/kg，p<0.001），报告的疼痛评分较低（2.5±1.8 与 3.7±1.6，p=0.002），并且住院时间较短（中位数[IQR]，27.3 [26.3-49.8] 与 32.4 [24.8-39.1] h，p<0.001）。使用多变量线性回归分析，控制其他可能的变量，如之前的性别肯定手术、心理健康诊断和手术时间后，ERAS 方案的实施独立预测了面部女性化手术后阿片类药物使用量减少、疼痛评分降低和住院时间缩短。
本研究详细介绍了一种用于面部女性化手术的 ERAS 方案，该方案减少了围手术期阿片类药物的使用、患者报告的疼痛评分和住院时间。
