Park John B, Adebagbo Oluwaseun D, Escobar-Domingo Maria J, Rahmani Benjamin, Tobin Micaela, Yamin Mohammed, Lee Daniela, Fanning James E, Prospero Matthew, Cauley Ryan P
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Ann Plast Surg. 2024 Oct 1;93(4):530-535. doi: 10.1097/SAP.0000000000004047. Epub 2024 Jul 15.
Gender-affirming top surgery is becoming increasingly common, with greater diversity in the patients receiving top surgery. The purpose of this study was to examine national trends in patient demographics, characteristics, wound complication rates, and concurrent procedures in patients receiving gender-affirming top surgeries.
Patients with gender dysphoria who underwent breast procedures, including mastectomy, mastopexy, breast augmentation, or breast reduction by a plastic surgeon between 2013 and 2022, were identified from the American College of Surgeons National Surgical Quality Improvement Program database. These procedures were considered to be gender-affirming "top surgery." Univariate analyses were performed to examine trend changes in the patient population and types of additional procedures performed over the last decade.
There was a 38-fold increase in the number of patients who received top surgery during the most recent years compared to the first 2 years of the decade. Significantly more individuals receiving top surgery in recent years were nonbinary ( P < 0.01). There was a significant decrease in percentage of active smokers ( P < 0.01) while there was an increase in percentage of patients with diabetes ( P = 0.03). While there was a significant increase in the number of obese patients receiving top surgery ( P < 0.01), there were no differences in postoperative wound complications between the years. Significantly more patients received additional procedures ( P < 0.01) and had about a 9-fold increase in distinct number of additional CPT codes from 2013-2014 to 2021-2022.
Our study found that there has been (1) a significant increase in the number of top surgery patients from 2013 to 2022 overall and (2) a particular increase in patients with preoperative comorbidities, such as a higher body mass index and diabetes. Understanding current and evolving trends in patients undergoing surgical treatment for gender dysphoria can inform individualized care plans that best serve the needs of patients and optimize overall outcomes.
性别肯定性胸部手术越来越普遍，接受胸部手术的患者群体日益多样化。本研究的目的是调查接受性别肯定性胸部手术患者的人口统计学特征、特点、伤口并发症发生率及同期手术的全国趋势。
从美国外科医师学会国家外科质量改进计划数据库中识别出2013年至2022年间接受乳房手术（包括乳房切除术、乳房固定术、隆胸术或乳房缩小术）的性别焦虑症患者，这些手术被视为性别肯定性“胸部手术”。进行单因素分析以研究过去十年患者群体和所施行的其他手术类型的趋势变化。
与该十年的前两年相比，近年来接受胸部手术的患者数量增加了38倍。近年来接受胸部手术的非二元性别者显著增多（P<0.01）。现吸烟者的比例显著下降（P<0.01），而糖尿病患者的比例有所上升（P=0.03）。虽然接受胸部手术的肥胖患者数量显著增加（P<0.01），但不同年份之间术后伤口并发症并无差异。接受其他手术的患者显著增多（P<0.01），从2013 - 2014年到2021 - 2022年，不同的附加现行程序编码数量增加了约9倍。
我们的研究发现，（1）2013年至2022年期间，胸部手术患者数量总体显著增加；（2）术前合并症患者，如体重指数较高和糖尿病患者的数量尤其增加。了解接受性别焦虑症手术治疗患者的当前及不断变化的趋势，可为制定最能满足患者需求并优化总体治疗效果的个性化护理计划提供参考。
