Temporary Declines and Demand Resurgence: Gender-Affirming Surgery Volume and Complication Trends During and After the COVID-19 Pandemic
Background 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. Methods The 2019–2021 National Surgical Quality Improv...
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| Veröffentlicht in: | Aesthetic plastic surgery 2024-09, Vol.48 (17), p.3520-3529 |
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| creator | Miller, Amitai S. Beagles, Clay B. Kaur, Manraj N. Marano, Andrew A. Hu, Sophia Ghoshal, Soham Dey, Tanujit Coon, Devin Succi, Marc D. |
| description | Background
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.
Methods
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.
Results
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.
Conclusions
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.
Important Points
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 disproportionate |
| doi_str_mv | 10.1007/s00266-024-04243-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3079173897</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3119854142</sourcerecordid><originalsourceid>FETCH-LOGICAL-c326t-70962f315612f2f0ed19870067fd2ca1e3208c11286979bcc3a69187c57036823</originalsourceid><addsrcrecordid>eNp9kcFu1DAURS0EokPhB1ggS2zYmPrZHjtmN5qBUqlSqzJU7KzUeS6p4iTYyYI_4LNxOoVKLFhZ9jv3PuteQl4Dfw-cm5PMudCacaEYV0JJJp-QFSgp2FooeEpWXGrFBOhvR-RFznecgzBGPSdHsrJWCGVX5Nce4zikOv2kO_Rd22Omdd-US1yOK8xzusXe4wd6in2DiW1CaFNs-1v6ZRkV4fXQzRHvZdshjl3r66kderpPRZHpbk4LvYw3YcJEp-9ItxfXZzsGll6Wd4ytf0mehbrL-OrhPCZfP33cbz-z84vTs-3mnHkp9MQMt1oECWsNIojAsQFbGc61CY3wNaAUvPIAotLW2BvvZa0tVMavTUmjEvKYvDv4jmn4MWOeXGyzx66rexzm7CQ3FkwJyBT07T_o3TCnvvzOSShr1wrUYigOlE9DzgmDG1MbS6AOuFt6coeeXOnJ3ffkZBG9ebCebyI2fyV_iimAPAB5XNLD9Lj7P7a_AYdfm7o</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3119854142</pqid></control><display><type>article</type><title>Temporary Declines and Demand Resurgence: Gender-Affirming Surgery Volume and Complication Trends During and After the COVID-19 Pandemic</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Miller, Amitai S. ; Beagles, Clay B. ; Kaur, Manraj N. ; Marano, Andrew A. ; Hu, Sophia ; Ghoshal, Soham ; Dey, Tanujit ; Coon, Devin ; Succi, Marc D.</creator><creatorcontrib>Miller, Amitai S. ; Beagles, Clay B. ; Kaur, Manraj N. ; Marano, Andrew A. ; Hu, Sophia ; Ghoshal, Soham ; Dey, Tanujit ; Coon, Devin ; Succi, Marc D.</creatorcontrib><description>Background
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.
Methods
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.
Results
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.
Conclusions
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.
Important Points
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.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of contents or the online Instructions to Authors
www.springer.com/00266
.</description><identifier>ISSN: 0364-216X</identifier><identifier>ISSN: 1432-5241</identifier><identifier>EISSN: 1432-5241</identifier><identifier>DOI: 10.1007/s00266-024-04243-3</identifier><identifier>PMID: 38992249</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Adult ; COVID-19 - epidemiology ; COVID-19 - prevention & control ; COVID-19 vaccines ; Databases, Factual ; Female ; Gender reassignment surgery ; Gender-affirming care ; Humans ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Original Articles ; Otorhinolaryngology ; Pandemics ; Plastic Surgery ; Postoperative Complications - epidemiology ; Retrospective Studies ; SARS-CoV-2 ; Sex Reassignment Surgery - methods ; Surgical outcomes ; Trends ; United States - epidemiology ; Young Adult</subject><ispartof>Aesthetic plastic surgery, 2024-09, Vol.48 (17), p.3520-3529</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-70962f315612f2f0ed19870067fd2ca1e3208c11286979bcc3a69187c57036823</cites><orcidid>0000-0001-6130-6810</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00266-024-04243-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00266-024-04243-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38992249$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Miller, Amitai S.</creatorcontrib><creatorcontrib>Beagles, Clay B.</creatorcontrib><creatorcontrib>Kaur, Manraj N.</creatorcontrib><creatorcontrib>Marano, Andrew A.</creatorcontrib><creatorcontrib>Hu, Sophia</creatorcontrib><creatorcontrib>Ghoshal, Soham</creatorcontrib><creatorcontrib>Dey, Tanujit</creatorcontrib><creatorcontrib>Coon, Devin</creatorcontrib><creatorcontrib>Succi, Marc D.</creatorcontrib><title>Temporary Declines and Demand Resurgence: Gender-Affirming Surgery Volume and Complication Trends During and After the COVID-19 Pandemic</title><title>Aesthetic plastic surgery</title><addtitle>Aesth Plast Surg</addtitle><addtitle>Aesthetic Plast Surg</addtitle><description>Background
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.
Methods
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.
Results
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.
Conclusions
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.
Important Points
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.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of contents or the online Instructions to Authors
www.springer.com/00266
.</description><subject>Adult</subject><subject>COVID-19 - epidemiology</subject><subject>COVID-19 - prevention & control</subject><subject>COVID-19 vaccines</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Gender reassignment surgery</subject><subject>Gender-affirming care</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Articles</subject><subject>Otorhinolaryngology</subject><subject>Pandemics</subject><subject>Plastic Surgery</subject><subject>Postoperative Complications - epidemiology</subject><subject>Retrospective Studies</subject><subject>SARS-CoV-2</subject><subject>Sex Reassignment Surgery - methods</subject><subject>Surgical outcomes</subject><subject>Trends</subject><subject>United States - epidemiology</subject><subject>Young Adult</subject><issn>0364-216X</issn><issn>1432-5241</issn><issn>1432-5241</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcFu1DAURS0EokPhB1ggS2zYmPrZHjtmN5qBUqlSqzJU7KzUeS6p4iTYyYI_4LNxOoVKLFhZ9jv3PuteQl4Dfw-cm5PMudCacaEYV0JJJp-QFSgp2FooeEpWXGrFBOhvR-RFznecgzBGPSdHsrJWCGVX5Nce4zikOv2kO_Rd22Omdd-US1yOK8xzusXe4wd6in2DiW1CaFNs-1v6ZRkV4fXQzRHvZdshjl3r66kderpPRZHpbk4LvYw3YcJEp-9ItxfXZzsGll6Wd4ytf0mehbrL-OrhPCZfP33cbz-z84vTs-3mnHkp9MQMt1oECWsNIojAsQFbGc61CY3wNaAUvPIAotLW2BvvZa0tVMavTUmjEvKYvDv4jmn4MWOeXGyzx66rexzm7CQ3FkwJyBT07T_o3TCnvvzOSShr1wrUYigOlE9DzgmDG1MbS6AOuFt6coeeXOnJ3ffkZBG9ebCebyI2fyV_iimAPAB5XNLD9Lj7P7a_AYdfm7o</recordid><startdate>20240901</startdate><enddate>20240901</enddate><creator>Miller, Amitai S.</creator><creator>Beagles, Clay B.</creator><creator>Kaur, Manraj N.</creator><creator>Marano, Andrew A.</creator><creator>Hu, Sophia</creator><creator>Ghoshal, Soham</creator><creator>Dey, Tanujit</creator><creator>Coon, Devin</creator><creator>Succi, Marc D.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6130-6810</orcidid></search><sort><creationdate>20240901</creationdate><title>Temporary Declines and Demand Resurgence: Gender-Affirming Surgery Volume and Complication Trends During and After the COVID-19 Pandemic</title><author>Miller, Amitai S. ; Beagles, Clay B. ; Kaur, Manraj N. ; Marano, Andrew A. ; Hu, Sophia ; Ghoshal, Soham ; Dey, Tanujit ; Coon, Devin ; Succi, Marc D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-70962f315612f2f0ed19870067fd2ca1e3208c11286979bcc3a69187c57036823</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>COVID-19 - epidemiology</topic><topic>COVID-19 - prevention & control</topic><topic>COVID-19 vaccines</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Gender reassignment surgery</topic><topic>Gender-affirming care</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Articles</topic><topic>Otorhinolaryngology</topic><topic>Pandemics</topic><topic>Plastic Surgery</topic><topic>Postoperative Complications - epidemiology</topic><topic>Retrospective Studies</topic><topic>SARS-CoV-2</topic><topic>Sex Reassignment Surgery - methods</topic><topic>Surgical outcomes</topic><topic>Trends</topic><topic>United States - epidemiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Miller, Amitai S.</creatorcontrib><creatorcontrib>Beagles, Clay B.</creatorcontrib><creatorcontrib>Kaur, Manraj N.</creatorcontrib><creatorcontrib>Marano, Andrew A.</creatorcontrib><creatorcontrib>Hu, Sophia</creatorcontrib><creatorcontrib>Ghoshal, Soham</creatorcontrib><creatorcontrib>Dey, Tanujit</creatorcontrib><creatorcontrib>Coon, Devin</creatorcontrib><creatorcontrib>Succi, Marc D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Aesthetic plastic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Miller, Amitai S.</au><au>Beagles, Clay B.</au><au>Kaur, Manraj N.</au><au>Marano, Andrew A.</au><au>Hu, Sophia</au><au>Ghoshal, Soham</au><au>Dey, Tanujit</au><au>Coon, Devin</au><au>Succi, Marc D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Temporary Declines and Demand Resurgence: Gender-Affirming Surgery Volume and Complication Trends During and After the COVID-19 Pandemic</atitle><jtitle>Aesthetic plastic surgery</jtitle><stitle>Aesth Plast Surg</stitle><addtitle>Aesthetic Plast Surg</addtitle><date>2024-09-01</date><risdate>2024</risdate><volume>48</volume><issue>17</issue><spage>3520</spage><epage>3529</epage><pages>3520-3529</pages><issn>0364-216X</issn><issn>1432-5241</issn><eissn>1432-5241</eissn><abstract>Background
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.
Methods
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.
Results
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.
Conclusions
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.
Important Points
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.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of contents or the online Instructions to Authors
www.springer.com/00266
.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>38992249</pmid><doi>10.1007/s00266-024-04243-3</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-6130-6810</orcidid></addata></record> |
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| ispartof | Aesthetic plastic surgery, 2024-09, Vol.48 (17), p.3520-3529 |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Adult COVID-19 - epidemiology COVID-19 - prevention & control COVID-19 vaccines Databases, Factual Female Gender reassignment surgery Gender-affirming care Humans Male Medicine Medicine & Public Health Middle Aged Original Articles Otorhinolaryngology Pandemics Plastic Surgery Postoperative Complications - epidemiology Retrospective Studies SARS-CoV-2 Sex Reassignment Surgery - methods Surgical outcomes Trends United States - epidemiology Young Adult |
| title | Temporary Declines and Demand Resurgence: Gender-Affirming Surgery Volume and Complication Trends During and After the COVID-19 Pandemic |
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