University of California, San Francisco San Francisco, California
Background: Gender-affirming surgery is a constellation of multiple surgical procedures ranging from extensive bony manipulation to soft tissue augmentation. Our institution generally performs these interventions as staged surgeries. Stage 1 involves extensive bony manipulation of the frontal bone, nasal framework and mandible. Stage 2 involves soft tissue manipulation. Postoperative pain management varies widely depending on the procedures performed. Learning Objectives: Understand postoperative narcotic requirements in different phases of gender affirming surgery. Study Objective: Investigate use of narcotics in stage 1 versus stage 2 gender affirming surgery Design Type: Retrospective analysis at a tertiary care facility Method: We reviewed 88 patients who underwent gender-affirming surgery at our institution. In most patients, the initial surgery included manipulation of the frontal bone, nasal framework and mandible. We compared length of hospital stay (LOS) and perioperative narcotic requirements in overall morphine equivalent units (MEU) between the staged surgeries. Results: Our study included 88 patients undergoing gender-affirming surgery. 85 patients underwent facial feminization, 3 patients underwent facial masculinization. 27 patients completed both stage 1 and stage 2 surgeries. 80.2 total inpatient MEUs were required in stage 1 surgery, 71.73 in stage 2 (p=0.62). MEUs on discharge were 57.07 after stage 1, 45.6 after stage 2 (p=0.24). LOS 1.22 (SD .71) days after stage 1, 0.74 (SD .76) days after stage 2. Conclusion: Gender affirming surgery is comprised of several surgical techniques. There appears to be no significant difference in perioperative narcotic requirements in bony versus soft tissue intervention.