From the Journals

Gender affirmation surgery has become more common

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Track outcomes to improve care

The study is thought provoking and suggests many areas for future study.

Gender-affirming surgery is the final step in a spectrum of treatments for gender identity disorders or transsexualism, including psychological counseling, hormonal therapies, and pubertal hormone blockers. Referrals for these treatments are increasing, and likely the demand for surgical treatment will also continue to increase.

A comprehensive database or other prospective tool to assess the comparative efficacy of these treatments, create quality metrics, and address long-term health or psychiatric outcomes should be pursued.

Future research must address cost effectiveness and cost burdens, given increased public funding for gender affirmation surgeries. Most longitudinal studies of patients who have undergone gender affirmation procedures have found high satisfaction rates with low rates of regret (less than 5%). However, when regret occurs, it can be surgically challenging and costly to reverse these procedures.

Marie Crandall , MD, is a professor of surgery at the University of Florida, Jacksonville. She made her comments in an editorial and had no industry disclosures (JAMA Surg. 2018 Feb 28. doi: 10.1001/jamasurg.2017.6232).


 

FROM JAMA SURGERY

“Our data suggest that genital surgery is the most common type of inpatient gender-affirming surgery; however, these data do not include gender-affirming surgical procedures performed in outpatient settings, which likely include most chest, breast, and facial surgery,” the investigators wrote.

Surgery patients in high-volume centers (performing more than 50 gender-affirming procedures per year) were mostly self-pay, while those admitted to low-volume centers were not. “It is possible that self-paying patients may be getting higher-quality care at high-volume centers, as has been observed in other types of surgery,” according to the investigators. There is a need for national clinical and patient-reported outcomes data to assess and improve the quality of gender-affirming surgery. Gender identity information should be a part of all electronic health records and reported back to national data repositories, they said.

The investigators are supported by the Patient-Centered Outcomes Research Institute, the Agency for Healthcare Research and Quality, and the National Institutes of Health, among others. They had no industry disclosures.

SOURCE: Canner JK et al. JAMA Surg. 2018 Feb 28. doi: 10.1001/jamasurg.2017.6231.

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