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Complications Following Gender-Affirming Surgery in Community Health Center Settings: the LEGACY Project Surgical Outcomes
Calvin R. Schuster
*, Sophia Hu, Ali Gunduz Sarioglu, Siti Rahmayanti, Devin Coon
Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
Background: Prior evidence demonstrates that complication rates differ between primary care vs. surgeon-based patient samples. The LEGACY Project is a PCORI-funded multi-site study that included gender-affirming surgery (GAS) complications as reported by patients and primary care providers.
Methods: Patient-reported outcomes from two large community health centers were collected. Complications were reported as free text. Complications were coded in duplicate by two authors, discrepancies were resolved by a third author. Fisher's exact test was used to compare transmasculine vs. transfeminine outcomes, classified as early healing, late healing, or aesthetic.
Results: A total of 1,116 gender-affirming surgeries were reported, the most common was chest masculinizing mastectomy (CMM) (n=402, 36%). 198 complications were evaluated across 13 surgery types. The complication rate was 17.2% for CMM, 17.6% for breast augmentation, 16.7% for vaginoplasty, and 7.4% for facial feminization surgery. The most common CMM complications were hematoma (n=20, 20.8%), scarring (n=15, 15.6%), and nipple graft necrosis (n=14, 14.6%). Aesthetic concerns included standing cutaneous deformities (n=8, 8.3%) and chest wall deformity (n=2, 2.1%). The most common hysterectomy complication was bleeding (n=5, 31.3%) followed by urinary dysfunction (n=2, 12.5%). Significantly more early healing complications compared to late healing complications occurred in transmasculine patients (n=98, n=37) as compared to transfeminine patients (n=15, n=12) (p=0.038).
Conclusion: This multi-institution project assessed patient-reported surgical complications from primary care settings, representing population-level data that offers more representative insights into GAS complication rates. Significantly more transmasculine patients experienced early wound healing complications compared to transfeminine patients. Future research is needed to investigate if this difference is due to properties of the surgeries being investigated, potential differences in exogenous hormone effects, or other causes.
