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Abstract：
Background: Gender-affirming mastectomy (GAM) improves the psychosocial functioning and quality of life of transgender and non-binary (TGNB) individuals. However, the perioperative period is often marked by emotional stress, concerns about surgical outcomes, and physical discomfort. While inpatient procedures provide multiple opportunities to engage with and educate patients, outpatient surgeries, such as GAM, pose a unique challenge as patients are followed for <24 h postoperatively. Given the heightened emotional and psychological distress related to gender dysphoria TGNB individuals often experience, addressing these gaps can significantly improve outcomes. This study aims to characterize patient and surgical characteristics associated with patient-initiated communication (PIC) frequency in this population. Methods: A single-center retrospective review of TGNB patients undergoing GAM from February 2018 to November 2022 was conducted. Demographics, surgical characteristics, and frequency of and reasons for perioperative PIC (30 days before and after surgery) were recorded. The primary outcome was the incidence of perioperative PIC. The secondary outcomes included (1) the rationale for PIC and (2) patient and surgical characteristics associated with PIC. Results: A total of 352 patients were included. Of these, 285 (74.6%) initiated communication in the perioperative period, totaling 659 PICs. The median age was 25.0 (interquartile range [IQR]: 9.0) years. The median body mass index (BMI) was 28.5 (IQR: 8.5) kg/m2. The mean number of PICs was 0.7 ± 1.3 preoperatively and 1.3 ± 1.7 postoperatively (p < 0.001). The most frequent preoperative PIC subjects were administrative issues (AI; n = 66, 30.7%), preoperative requirements (n = 43, 20.0%), and cost and insurance (n = 33, 15.0%). The most frequent postoperative PIC subjects were wound care (n = 77, 17.3%), AI (n = 70, 15.0%), activity restrictions (n = 60, 13.5%), drainage (n = 56, 12.6%), and swelling (n = 37, 8.3%). Collectively, older patients (β = 0.234, p = 0.001), those with a history of major depressive disorder or generalized anxiety disorder (2.4 ± 3.0 vs. 1.7 ± 1.9; p = 0.019), and those without postoperative drains (n = 16/17, 94.1% vs. n = 236/334, 70.7%; p = 0.025) engaged in higher levels of PIC. There were no significant associations between other patient characteristics, perioperative details, or complications and PIC frequency. Conclusions: Perioperative PIC is prevalent among the majority of GAM patients at our institution, with age, psychiatric diagnosis, and postoperative drain use identified as significant predictors. To mitigate PIC frequency, it is crucial to ensure adequate support staffing and provide comprehensive postoperative instructions, particularly concerning activity restrictions and drainage management. These interventions may reduce PICs in high-volume centers. Further research should investigate targeted interventions to further support TGNB patients during the perioperative period.
摘要：
背景：性别确认乳房切除术（GAM）可改善跨性别和非双性恋（TGNB）个体的心理社会功能和生活质量。然而,围手术期通常以情绪压力为标志，对手术结果的担忧，和身体不适。虽然住院手术提供了与患者互动和教育的多种机会，门诊手术,比如GAM,由于患者术后随访<24小时，因此构成了独特的挑战。鉴于TGNB个体经常经历的与性别焦虑相关的情绪和心理困扰加剧，解决这些差距可以显着改善结果。这项研究旨在表征该人群中与患者发起的沟通（PIC）频率相关的患者和手术特征。方法:对2018年2月至2022年11月接受GAM的TGNB患者进行单中心回顾性分析。人口统计,手术特点,记录围手术期PIC的频率和原因（手术前后30天）。主要结果是围手术期PIC的发生率。次要结果包括（1）PIC的基本原理和（2）患者和与PIC相关的手术特征。结果：共纳入352例患者。其中,285（74.6%）在围手术期开始沟通，总共659个PIC。中位年龄为25.0岁（四分位距[IQR]：9.0）。中位体重指数(BMI)为28.5(IQR:8.5)kg/m2。术前平均PIC数为0.7±1.3，术后为1.3±1.7（p<0.001）。术前PIC受试者最常见的是行政问题（AI；n=66，30.7%），术前要求（n=43，20.0%），以及成本和保险(n=33，15.0%)。术后最常见的PIC受试者是伤口护理（n=77，17.3％），AI（n=70，15.0%），活动限制(n=60，13.5%)，排水量(n=56，12.6%)，和肿胀（n=37，8.3％）。总的来说，老年患者（β=0.234，p=0.001），有重度抑郁症或广泛性焦虑症病史的人(2.4±3.0vs.1.7±1.9；p=0.019），和那些没有术后引流（n=16/17，94.1%vs.n=236/334，70.7%；p=0.025）从事更高水平的PIC。其他患者特征之间没有显著关联，围手术期细节，或并发症和PIC频率。结论：围手术期PIC在我们机构的大多数GAM患者中普遍存在，随着年龄,精神病诊断,术后引流使用被确定为重要的预测因素。为了减轻PIC频率，确保足够的支持人员和提供全面的术后指导至关重要，特别是关于活动限制和排水管理。这些干预措施可能会减少高容量中心的PIC。进一步的研究应探讨有针对性的干预措施，以进一步支持TGNB患者围手术期。
