Ambulatory facial feminization surgery: a comparative analysis of outcomes and complications

Nghiem Nguyen; Leandra Doan; Fang Jiang; Michael W Chu; Yuan Y Liu; Stacey H Francis; Holly Kim; James C Lee

doi:10.1016/j.bjps.2024.03.017

Ambulatory facial feminization surgery: a comparative analysis of outcomes and complications

J Plast Reconstr Aesthet Surg. 2024 Mar 22:93:30-35. doi: 10.1016/j.bjps.2024.03.017. Online ahead of print.

Authors

Nghiem Nguyen¹, Leandra Doan¹, Fang Jiang², Michael W Chu³, Yuan Y Liu², Stacey H Francis³, Holly Kim⁴, James C Lee⁵

Affiliations

¹ Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, USA.
² Southern California Permanente Medical Group, Los Angeles, CA, USA.
³ Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, USA; Southern California Permanente Medical Group, Los Angeles, CA, USA; Division of Plastic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA.
⁴ Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, USA; Southern California Permanente Medical Group, Los Angeles, CA, USA.
⁵ Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, USA; Southern California Permanente Medical Group, Los Angeles, CA, USA; Division of Plastic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA. Electronic address: drjamescleemd@gmail.com.

PMID: 38631083
DOI: 10.1016/j.bjps.2024.03.017

Abstract

Background: To date, there are no studies investigating the safety and outcomes of facial feminization surgery (FFS) as an outpatient procedure. This is the first study of its kind analyzing the outcomes of ambulatory FFS based on a comparison of complications, post-operative emergency department or urgent care (ED/UC) visits, and readmissions between patients who underwent FFS with admission versus same-day surgery.

Methods: A retrospective analysis was conducted on all patients who underwent FFS in a single integrated healthcare system. Patient charts were reviewed for operative details, complications, post-operative ED/UC visits, readmission, and demographic factors. Major outcomes including complications, readmissions, and ED/UC visits were compared between groups with same-day discharge and post-operative hospital admission.

Results: Of 242 patients included in the study, ED/UC visits were comparable between patients discharged same-day (18.2%) and patients admitted post-operatively (21.6%, p = 0.52). Logistic regression showed no significant difference in the composite outcomes of minor complications, major complications, and readmissions (15.6% for ambulatory versus 19.3% for admission, p = 0.46). Temporary nerve palsy, infection, and hematoma were the most common post-operative complications. However, covariates of a lower face procedure and operative time were shown to have significant differences in the composite complication outcome (p = 0.04 and p = 0.045, respectively).

Conclusion: Ambulatory FFS is a safe practice with no associated increase in adverse outcomes including complications, ED/UC visits, and readmission when compared to post-operative admission. Adoption of same-day FFS should be considered by high-volume gender health centers to potentially benefit from increased scheduling flexibility and efficiency, increased access to care, and lower healthcare costs.

Keywords: Ambulatory surgery; Facial feminization surgery; Gender-affirmation surgery; Transgender; Transsexual.