Marquez Jessica L, Sudduth Jack D, Patel Ashraf A, Eddington Devin, Lewis Priya, Agarwal Cori
Division of Plastic Surgery, Department of Surgery, University of Utah Hospital, Salt Lake City, Utah, USA.
Division of Epidemiology, Department of Internal Medicine, University of Utah Hospital, Salt Lake City, Utah, USA.
Transgend Health. 2025 Apr 11;10(2):178-184. doi: 10.1089/trgh.2023.0112. eCollection 2025 Apr.
Often, body mass index (BMI) thresholds may be used to determine surgical candidacy in gender-affirming chest masculinization, but evidence for using these as surgical criteria has not been established. We sought to analyze a national cohort of patients undergoing mastectomy for gender affirmation to assess the risk of postoperative complications among different BMI categories.
The National Surgical Quality Improvement Program database (from 2010 to 2020) was queried to identify all encounters of mastectomy for gender affirmation. Cases were stratified by BMI categories and 30-day postoperative medical and surgical complications were compared.
A total of 10,775 patients were queried. The overall proportions of medical complications remained low for all groups. Incremental increases in the proportions of readmission, return to the operating room, wound infection, and wound dehiscence were observed with each increase in BMI category (=0.001). A multivariate regression model controlling for age, diabetes, American Society of Anesthesiologists (ASA) class, and operative time demonstrated a statistically significant increase in odds ratio (OR) for complications in the obesity II (OR 1.59, <0.001) and obesity III (OR 1.85, <0.001) cohorts. Age (OR 1.08, <0.001), diabetes (OR 1.4, =0.016), and increased operative time (OR 1.22, <0.001) were independently associated with an increase in odds of surgical complications.
While the obesity II and III cohorts experienced increased odds of complications, the authors suggest that these complications are not prohibitive. In the setting of comprehensive informed consent, obesity alone should not act as a contraindication to surgery in suitable candidates.
在性别肯定性胸部男性化手术中，体重指数（BMI）阈值常被用于确定手术候选资格，但将其用作手术标准的证据尚未确立。我们试图分析一组接受性别肯定性乳房切除术的全国性患者队列，以评估不同BMI类别患者术后并发症的风险。
查询国家外科质量改进计划数据库（2010年至2020年），以确定所有性别肯定性乳房切除术病例。病例按BMI类别分层，并比较术后30天的内科和外科并发症。
共查询了10775例患者。所有组的内科并发症总体比例仍然较低。随着BMI类别的增加，再入院、返回手术室、伤口感染和伤口裂开的比例逐渐增加（=0.001）。一个控制年龄、糖尿病、美国麻醉医师协会（ASA）分级和手术时间的多变量回归模型显示，肥胖II组（比值比[OR]1.59，<0.001）和肥胖III组（OR 1.85，<0.001）并发症的比值比有统计学显著增加。年龄（OR 1.08，<0.001）、糖尿病（OR 1.4，=0.016）和手术时间增加（OR 1.22，<0.001）与手术并发症几率增加独立相关。
虽然肥胖II组和III组并发症几率增加，但作者认为这些并发症并非不可接受。在充分知情同意的情况下，仅肥胖不应成为合适候选者手术的禁忌证。
