TY - JOUR
T1 - Gender Affirming Surgery
T2 - A Comprehensive, Systematic Review of All Peer-reviewed Literature and Methods of Assessing Patientcentered Outcomes (Part 1: Breast/Chest, Face, and Voice)
AU - Oles, Norah
AU - Darrach, Halley
AU - Landford, Wilmina
AU - Garza, Matthew
AU - Twose, Claire
AU - Park, Chanjun S.
AU - Tran, Phuong
AU - Schechter, Loren S.
AU - Lau, Brandyn
AU - Coon, Devin
N1 - Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/1/1
Y1 - 2022/1/1
N2 - Objective: To perform the first systematic review of all available genderaffirming surgery (GAS) publications across all procedures to assess both outcomes reported in the literature and the methods used for outcome assessment. Summary of Background Data: Rapidly increasing clinical volumes of gender-affirming surgeries have stimulated a growing need for high-quality clinical research. Although some procedures have been performed for decades, each individual procedure has limited data, necessitating synthesis of the entire literature to understand current knowledge and guide future research. Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify all outcomes measures in GAS cohorts, including PCOs, complications, and functional outcomes. Outcome data were pooled to assess currently reported complication, satisfaction, and other outcome rates. Results: Overall, 15,186 references were identified, 4162 papers advanced to abstract review, and 1826 underwent full-text review. After review, there were 406 GAS cohort publications. Of non-genitoplasty titles, 35 were mastectomy, 6mammoplasty, 21 facial feminization, and 31 voice/cartilage. Although 59.1% of non-genitoplasty papers addressed PCOs in some form, only 4.3% used instruments partially-validated in transgender patients. Overall, data were reported heterogeneously and were biased towards high-volume centers. Conclusions: This study represents the most comprehensive review of GAS literature. By aggregating all previously utilized measurement instruments, this study offers a foundation for discussions about current methodologic limitations and what dimensions must be included in assessing surgical success. We have assembled a comprehensive list of outcome instruments; this offers an ideal starting basis for emerging discussions between patients and providers about deficiencies which new, better instruments and metrics must address. The lack of consistent use of the same outcome measures and validated GAS-specific instruments represent the 2 primary barriers to highquality research where improvement efforts should be focused.
AB - Objective: To perform the first systematic review of all available genderaffirming surgery (GAS) publications across all procedures to assess both outcomes reported in the literature and the methods used for outcome assessment. Summary of Background Data: Rapidly increasing clinical volumes of gender-affirming surgeries have stimulated a growing need for high-quality clinical research. Although some procedures have been performed for decades, each individual procedure has limited data, necessitating synthesis of the entire literature to understand current knowledge and guide future research. Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify all outcomes measures in GAS cohorts, including PCOs, complications, and functional outcomes. Outcome data were pooled to assess currently reported complication, satisfaction, and other outcome rates. Results: Overall, 15,186 references were identified, 4162 papers advanced to abstract review, and 1826 underwent full-text review. After review, there were 406 GAS cohort publications. Of non-genitoplasty titles, 35 were mastectomy, 6mammoplasty, 21 facial feminization, and 31 voice/cartilage. Although 59.1% of non-genitoplasty papers addressed PCOs in some form, only 4.3% used instruments partially-validated in transgender patients. Overall, data were reported heterogeneously and were biased towards high-volume centers. Conclusions: This study represents the most comprehensive review of GAS literature. By aggregating all previously utilized measurement instruments, this study offers a foundation for discussions about current methodologic limitations and what dimensions must be included in assessing surgical success. We have assembled a comprehensive list of outcome instruments; this offers an ideal starting basis for emerging discussions between patients and providers about deficiencies which new, better instruments and metrics must address. The lack of consistent use of the same outcome measures and validated GAS-specific instruments represent the 2 primary barriers to highquality research where improvement efforts should be focused.
KW - Breast augmentation
KW - Chest masculinization
KW - Facial feminization
KW - Functional outcomes of surgery
KW - Gender confirmation surgery
KW - Gender-affirming surgery
KW - Mastectomy
KW - Meta-analysis
KW - Outcomes measures
KW - Patient satisfaction
KW - Patient-reported outcomes
KW - Plastic surgery
KW - Reconstructive surgery
KW - Surgical complication
KW - Systematic review
KW - Thryrochondroplasty
KW - Top surgery
KW - Transgender
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U2 - 10.1097/SLA.0000000000004728
DO - 10.1097/SLA.0000000000004728
M3 - Review article
C2 - 33443903
AN - SCOPUS:85111941055
SN - 0003-4932
VL - 275
SP - E52-E66
JO - Annals of surgery
JF - Annals of surgery
IS - 1
ER -