Harvard Medical School, Boston, MA, USA.
Harvard University John F. Kennedy School of Government, Cambridge, MA, USA.
Aesthetic Plast Surg. 2024 Sep;48(17):3520-3529. doi: 10.1007/s00266-024-04243-3. Epub 2024 Jul 11.
The COVID-19 pandemic prompted surgical volume reductions due to lockdown measures. This study evaluates COVID-19's impact on gender-affirming surgery (GAS) volume and complications from the pandemic onset through the recovery period.
The 2019-2021 National Surgical Quality Improvement Program databases were queried for transgender or gender-diverse patients using ICD-10 codes. Five time periods were analyzed: Pre-pandemic, Immediate pre-pandemic and COVID-19 outbreak, Initial COVID-19 peak, Pre-COVID-19 vaccine, and Post-vaccine release. Complications included reoperation, urinary tract infections, and wound complications. Multivariate logistic regressions assessed factors associated with undergoing surgery during the initial COVID-19 peak and experiencing surgical complications.
Out of 2,963,230 patients, 4637 underwent GAS between 2019 and 2021. Chest feminizing and masculinizing procedures comprised 60.1% of all GAS. During the initial COVID-19 peak, all GAS surgeries nearly halved, with breast augmentations dropping to 15.3% of pre-pandemic volumes. White patients constituted a significantly higher proportion of GAS patients during the initial COVID-19 peak than in 2019 (74.7% vs. 61.0%, p = 0.014). Post-vaccine, GAS levels surged, exceeding pre-pandemic volumes by 45.5% and initial peak levels by 188.5%. The overall complication rate was 4.9%, and was significantly associated with older age, increased operative time, feminizing and masculinizing genital surgeries, and hysterectomies. The initial COVID-19 peak showed no significant correlations with surgical complications.
GAS volume temporarily decreased during the initial COVID-19 outbreak and has since rebounded and surpassed pre-pandemic levels, corresponding with past-decade trends. Complication risks remained consistent despite the pandemic, though the results highlight potentially significant race-based disparities in GAS access during COVID-19.
During the COVID-19 pandemic, public health measures led to severe volume reductions in gender-affirming surgical (GAS) procedures. Since the initial COVID-19 peak, GAS volumes have fully recovered and surpassed pre-pandemic volumes. Surgical complication rates for various GAS procedures were within expected ranges, emphasizing the overall safety of these surgeries. The study's results highlight racial disparities in undergoing GAS during the COVID-19 pandemic, with White patients disproportionately represented among those who had surgery during the COVID-19 lockdown.
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由于封锁措施，COVID-19 大流行导致手术量减少。本研究评估了 COVID-19 对性别肯定手术（GAS）量的影响，并从大流行开始到恢复期对并发症进行了评估。
使用 ICD-10 代码在 2019-2021 年全国手术质量改进计划数据库中查询跨性别或性别多样化患者。分析了五个时间段：大流行前、大流行前和 COVID-19 爆发期间、COVID-19 初期高峰、COVID-19 疫苗前和疫苗发布后。并发症包括再次手术、尿路感染和伤口并发症。多变量逻辑回归评估了与 COVID-19 初期高峰期间接受手术和经历手术并发症相关的因素。
在 2963230 名患者中，有 4637 名患者在 2019 年至 2021 年期间接受了 GAS。胸部女性化和男性化手术占所有 GAS 的 60.1%。在 COVID-19 初期高峰期间，所有 GAS 手术几乎减半，乳房增大术降至大流行前水平的 15.3%。在 COVID-19 初期高峰期间，白人患者在 GAS 患者中的比例明显高于 2019 年（74.7%比 61.0%，p=0.014）。疫苗发布后，GAS 水平飙升，比大流行前水平高出 45.5%，比 COVID-19 初期高峰水平高出 188.5%。总体并发症发生率为 4.9%，与年龄较大、手术时间延长、女性化和男性化生殖器手术以及子宫切除术显著相关。COVID-19 初期高峰与手术并发症无显著相关性。
COVID-19 爆发期间，GAS 量暂时减少，此后已反弹并超过大流行前水平，与过去十年的趋势相符。尽管大流行，但并发症风险仍然保持一致，但结果突出了 COVID-19 期间 GAS 获得方面潜在的显著种族差异。
在 COVID-19 大流行期间，公共卫生措施导致性别肯定手术（GAS）程序的数量严重减少。自 COVID-19 初期高峰以来，GAS 量已完全恢复并超过了大流行前的水平。各种 GAS 手术的并发症发生率在预期范围内，强调了这些手术的总体安全性。研究结果突出了 COVID-19 大流行期间接受 GAS 手术方面的种族差异，在 COVID-19 封锁期间接受手术的患者中，白人患者比例过高。
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