Association of High Body Mass Index With Postoperative Complications After Chest Masculinization Surgery.
Journal
Annals of plastic surgery
ISSN: 1536-3708
Titre abrégé: Ann Plast Surg
Pays: United States
ID NLM: 7805336
Informations de publication
Date de publication:
01 Nov 2023
01 Nov 2023
Historique:
medline:
2
11
2023
pubmed:
2
11
2023
entrez:
2
11
2023
Statut:
aheadofprint
Résumé
Body mass index (BMI) requirements for transgender and nonbinary patients undergoing chest masculinization surgery (CMS) are not standardized and based on small sample sizes. This is the largest and first national retrospective study to determine the association between BMI and postoperative complications. The National Surgical Quality Improvement Program 2012-2020 was queried for CMS patients. The primary outcome was incidence of at least one complication within 30 days. Secondary outcomes were incidence of major and minor complications. Body mass index (in kilograms per square meter) was categorized as category 0 (<30), 1 (30-34.9), 2 (35-39.9), 3 (40-44.9), 4 (45-49.9), and 5 (≥50). Logistic regression was used to evaluate the association between BMI and outcomes. Of 2317 patients, median BMI was 27.4 kg/m2 (interquartile range, 23.4-32.2 kg/m2). Body mass index range was 15.6 to 64.9 kg/m2. While increasing BMI was significantly associated with greater odds of at least one complication, no patients experienced severe morbidity, regardless of BMI. Patients with BMI ≥50 kg/m2 had an adjusted odds ratio [aOR, 95% confidence interval (CI)] of 3.63 (1.02-12.85) and 36.62 (2.96->100) greater odds of at least one complication and urinary tract infection compared with nonobese patients, respectively. Patients with BMI ≥35 kg/m2 had an adjusted odds ratio (95% CI) of 5.06 (1.5-17.04) and 5.13 (1.89-13.95) greater odds of readmission and surgical site infection compared with nonobese patients, respectively. Chest masculinization surgery in higher BMI patients is associated with greater odds of unplanned readmission. Given the low risk for severe complications in higher BMI individuals, we recommend re-evaluation of BMI cutoffs for CMS patients.
Identifiants
pubmed: 37917575
doi: 10.1097/SAP.0000000000003737
pii: 00000637-990000000-00345
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of interest and sources of funding: none declared.
Références
Call DC, Challa M, Telingator CJ. Providing affirmative care to transgender and gender diverse youth: disparities, interventions, and outcomes. Curr Psychiatry Rep. 2021;23:33.
Safer JD, Coleman E, Feldman J, et al. Barriers to healthcare for transgender individuals. Curr Opin Endocrinol Diabetes Obes. 2016;23:168–171.
Martinson TG, Ramachandran S, Lindner R, et al. High body mass index is a significant barrier to gender-confirmation surgery for transgender and gender-nonbinary individuals. Endocr Pract. 2020;26:6–15.
Brownstone LM, DeRieux J, Kelly DA, et al. Body mass index requirements for gender-affirming surgeries are not empirically based. Transgend Health. 2021;6:121–124.
Myung Y, Heo CY. Relationship between obesity and surgical complications after reduction mammaplasty: a systematic literature review and meta-analysis. Aesthet Surg J. 2017;37:308–315.
Jiang J, Teng Y, Fan Z, et al. Does obesity affect the surgical outcome and complication rates of spinal surgery? A meta-analysis. Clin Orthop Relat Res. 2014;472:968–975.
Bishop A, Overcash F, McGuire J, et al. Diet and physical activity behaviors among adolescent transgender students: school survey results. J Adolesc Health. 2020;66:484–490.
Olson-Kennedy J, Warus J, Okonta V, et al. Chest reconstruction and chest dysphoria in transmasculine minors and young adults: comparisons of nonsurgical and postsurgical cohorts. JAMA Pediatr. 2018;172:431–436.
Monstrey SJ, Ceulemans P, Hoebeke P. Sex reassignment surgery in the female-to-male transsexual. Semin Plast Surg. 2011;25:229–244.
Agarwal CA, Scheefer MF, Wright LN, et al. Quality of life improvement after chest wall masculinization in female-to-male transgender patients: a prospective study using the BREAST-Q and Body Uneasiness Test. J Plast Reconstr Aesthet Surg. 2018;71:651–657.
Perez-Alvarez IM, Zolper EG, Schwitzer J, et al. Incidence of complications in chest wall masculinization for the obese female-to-male transgender population: a case series. World J Plast Surg. 2021;10:14–24.
Pittelkow EM, Duquette SP, Rhamani F, et al. Female-to-male gender-confirming drainless mastectomy may be safe in obese males. Aesthet Surg J. 2020;40:NP85–NP93.
Rothenberg KA, Gologorsky RC, Hojilla JC, et al. Gender-affirming mastectomy in transmasculine patients: does obesity increase complications or revisions? Ann Plast Surg. 2021;87:24–30.
ACSAbout ACS NSQIP. Available at: https://www.facs.org/quality-programs/data-and-registries/acs-nsqip/about-acs-nsqip/. Accessed December 29, 2022
Centers for Disease Control and Prevention. Defining adult overweight and obesity. Available at: https://www.cdc.gov/obesity/basics/adult-defining.html. Accessed December 29, 2022
Jiang L, Rong J, Wang Y, et al. The relationship between body mass index and hip osteoarthritis: a systematic review and meta-analysis. Joint Bone Spine. 2011;78:150–155.
Schwarzkopf R, Thompson SL, Adwar SJ, et al. Postoperative complication rates in the “super-obese” hip and knee arthroplasty population. J Arthroplasty. 2012;27:397–401.
ACS NSQIP. User guide for the 2021 ACS NSQIP procedure targeted participant use data file (PUF). Available at: https://www.facs.org/media/tjcd1biq/nsqip_puf_userguide_2021_20221102120632.pdf. Accessed December 29, 2022
IBM. IBM SPSS Statistics 28 brief guide. Available at: https://www.ibm.com/docs/en/SSLVMB_28.0.0/pdf/IBM_SPSS_Statistics_Brief_Guide.pdf. Accessed December 29, 2022
Bamgbade OA, Rutter TW, Nafiu OO, et al. Postoperative complications in obese and nonobese patients. World J Surg. 2017;31:556–560; discussion 561.
Cuccolo NG, Kang CO, Boskey ER, et al. Mastectomy in transgender and cisgender patients: a comparative analysis of epidemiology and postoperative outcomes. Plast Reconstr Surg Glob Open. 2019;7:e2316.
Bailey L, Ellis SJ, McNeil J. Suicide risk in the UK trans population and the role of gender transition in decreasing suicidal ideation and suicide attempt. Ment Health Rev J. 2014;19:209–220.
Foster Skewis L, Bretherton I, Leemaqz SY, et al. Short-term effects of gender-affirming hormone therapy on dysphoria and quality of life in transgender individuals: a prospective controlled study. Front Endocrinol. 2021;12:717766.
Meier AC, Papadopulos N. Quality of life after gender reassignment surgery: an overview. Handchir Mikrochir Plast Chir. 2021;53:556–563.
Seelman KL, Colón-Diaz MJP, LeCroix RH, et al. Transgender noninclusive healthcare and delaying care because of fear: connections to general health and mental health among transgender adults. Transgend Health. 2017;2:17–28.
Tordoff DM, Wanta JW, Collin A, et al. Mental health outcomes in transgender and non-binary youths receiving gender-affirming care. JAMA Netw Open. 2022;5:e220978.
Coleman E, Bockting W, Botzer M, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgenderism. 2012;13:165–232.
Safa B, Lin WC, Salim AM, et al. Current concepts in masculinizing gender surgery. Plast Reconstr Surg. 2019;143:857e–871e.
Nagata JM, Ganson KT, Austin SB. Emerging trends in eating disorders among sexual and gender minorities. Curr Opin Psychiatry. 2020;33:562–567.
Diemer EW, Grant JD, Munn-Chernoff MA, et al. Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. J Adolesc Health. 2015;57:144–149.
Wang Y, Beydoun MA. The obesity epidemic in the United States--gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev. 2007;29:6–28.
Brown GR, Jones KT. Racial health disparities in a cohort of 5,135 transgender veterans. J Racial Ethn Health Disparities. 2014;1:257–266.
Robertson L, Akré ER, Gonzales G. Mental health disparities at the intersections of gender identity, race, and ethnicity. LGBT Health. 2021;8:526–535.
Seelman KL, Young SR, Tesene M, et al. A comparison of health disparities among transgender adults in Colorado (USA) by race and income. Int J Transgen. 2017;18:199–214.
Guyatt GH, Akl EA, Crowther M, et al. Introduction to the ninth edition: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):48S–52S.
Kikura M, Oikawa F, Yamamoto K, et al. Myocardial infarction and cerebrovascular accident following non-cardiac surgery: differences in postoperative temporal distribution and risk factors. J Thromb Haemost. 2008;6:742–748.