Gender affirmation surgery has become more common

 

The number of gender-affirming surgeries is increasing annually in the United States, and private insurers and Medicare and Medicaid are covering more of them, according to a review of the National Inpatient Sample from 2000 to 2014.

“As coverage for these procedures increases, likely so will demand for qualified surgeons to perform them,” said investigators led by Joseph Canner, MHS, of Johns Hopkins University, Baltimore (JAMA Surg. 2018 Feb 28. doi: 10.1001/jamasurg.2017.6231).

The team sought to correct a glaring lack of demographic, hospital, and surgical data on transgender people, a problem due mainly to “the absence of routine, standardized collection and reporting of gender identity in health care settings,” the investigators said.

The Affordable Care Act banned gender identity discrimination, and state and federal governments – as well as private insurers – are expanding coverage of gender affirmation surgery and care. Given the trend, it’s essential that quality improvement agencies begin to “focus on adopting a new set of patient-centered measures to better monitor transgender care and identify opportunities for advancing transition-related services,” the researchers said.

 

The team identified 37,827 hospital encounters in the national database that had ICD-9 diagnosis codes of transsexualism or gender identity disorder that were listed in the National Inpatient Sample. The rate of those codes increased from 3.87/100,000 patients in 2000 to 14.22 /100,000 patients in 2014.

Mental health was the leading cause of hospitalization, accounting for 40.5% of admissions, a finding that “is consistent with the high prevalence of depression, anxiety, and suicidal ideation in this population,” the investigators said.

Patients were a median age of 38 years old; 57.1% identified as white; and 54.3% were categorized as male, 38.3% as female, and most of the rest as “inconsistent,” meaning their sex in the medical record did not match their procedures.

Almost 11% were hospitalized for gender affirmation surgery, including penile or vaginal construction. From 2000 to 2005, 72% of patients who underwent affirmation procedures had genital surgery; the number increased to 83.9% from 2006 to 2011. More than half of the patients weren’t covered by insurance, but the number covered by Medicare or Medicaid increased from 25 patients in 2012-2013 to 70 in 2014. Meanwhile, no one died in the hospital from gender reassignment surgery, and the median stay was 4 days.

 

“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.
 

[email protected]

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

 

The number of gender-affirming surgeries is increasing annually in the United States, and private insurers and Medicare and Medicaid are covering more of them, according to a review of the National Inpatient Sample from 2000 to 2014.

“As coverage for these procedures increases, likely so will demand for qualified surgeons to perform them,” said investigators led by Joseph Canner, MHS, of Johns Hopkins University, Baltimore (JAMA Surg. 2018 Feb 28. doi: 10.1001/jamasurg.2017.6231).

The team sought to correct a glaring lack of demographic, hospital, and surgical data on transgender people, a problem due mainly to “the absence of routine, standardized collection and reporting of gender identity in health care settings,” the investigators said.

The Affordable Care Act banned gender identity discrimination, and state and federal governments – as well as private insurers – are expanding coverage of gender affirmation surgery and care. Given the trend, it’s essential that quality improvement agencies begin to “focus on adopting a new set of patient-centered measures to better monitor transgender care and identify opportunities for advancing transition-related services,” the researchers said.

 

The team identified 37,827 hospital encounters in the national database that had ICD-9 diagnosis codes of transsexualism or gender identity disorder that were listed in the National Inpatient Sample. The rate of those codes increased from 3.87/100,000 patients in 2000 to 14.22 /100,000 patients in 2014.

Mental health was the leading cause of hospitalization, accounting for 40.5% of admissions, a finding that “is consistent with the high prevalence of depression, anxiety, and suicidal ideation in this population,” the investigators said.

Patients were a median age of 38 years old; 57.1% identified as white; and 54.3% were categorized as male, 38.3% as female, and most of the rest as “inconsistent,” meaning their sex in the medical record did not match their procedures.

Almost 11% were hospitalized for gender affirmation surgery, including penile or vaginal construction. From 2000 to 2005, 72% of patients who underwent affirmation procedures had genital surgery; the number increased to 83.9% from 2006 to 2011. More than half of the patients weren’t covered by insurance, but the number covered by Medicare or Medicaid increased from 25 patients in 2012-2013 to 70 in 2014. Meanwhile, no one died in the hospital from gender reassignment surgery, and the median stay was 4 days.

 

“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.
 

[email protected]

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

 

The number of gender-affirming surgeries is increasing annually in the United States, and private insurers and Medicare and Medicaid are covering more of them, according to a review of the National Inpatient Sample from 2000 to 2014.

“As coverage for these procedures increases, likely so will demand for qualified surgeons to perform them,” said investigators led by Joseph Canner, MHS, of Johns Hopkins University, Baltimore (JAMA Surg. 2018 Feb 28. doi: 10.1001/jamasurg.2017.6231).

The team sought to correct a glaring lack of demographic, hospital, and surgical data on transgender people, a problem due mainly to “the absence of routine, standardized collection and reporting of gender identity in health care settings,” the investigators said.

The Affordable Care Act banned gender identity discrimination, and state and federal governments – as well as private insurers – are expanding coverage of gender affirmation surgery and care. Given the trend, it’s essential that quality improvement agencies begin to “focus on adopting a new set of patient-centered measures to better monitor transgender care and identify opportunities for advancing transition-related services,” the researchers said.

 

The team identified 37,827 hospital encounters in the national database that had ICD-9 diagnosis codes of transsexualism or gender identity disorder that were listed in the National Inpatient Sample. The rate of those codes increased from 3.87/100,000 patients in 2000 to 14.22 /100,000 patients in 2014.

Mental health was the leading cause of hospitalization, accounting for 40.5% of admissions, a finding that “is consistent with the high prevalence of depression, anxiety, and suicidal ideation in this population,” the investigators said.

Patients were a median age of 38 years old; 57.1% identified as white; and 54.3% were categorized as male, 38.3% as female, and most of the rest as “inconsistent,” meaning their sex in the medical record did not match their procedures.

Almost 11% were hospitalized for gender affirmation surgery, including penile or vaginal construction. From 2000 to 2005, 72% of patients who underwent affirmation procedures had genital surgery; the number increased to 83.9% from 2006 to 2011. More than half of the patients weren’t covered by insurance, but the number covered by Medicare or Medicaid increased from 25 patients in 2012-2013 to 70 in 2014. Meanwhile, no one died in the hospital from gender reassignment surgery, and the median stay was 4 days.

 

“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.
 

[email protected]

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