Association between genital gender-affirming surgery and psychiatric comorbidities in individuals with gender incongruence.

BACKGROUND: Previous studies present mixed evidence on the relationship between psychiatric comorbidities and genital gender-affirming surgery (GGAS) in individuals with gender incongruence (GI). AIM: This research aims to investigate the psychiatric comorbidity rates post-GGAS in the GI population-namely, depressive disorders, anxiety disorders, posttraumatic stress disorders, substance abuse disorder, and suicidality. METHODS: Based on the TriNetX health care database, an international database with >250 million patients, a cross-sectional study was executed comparing psychiatric comorbidity rates among cases of GI with and without GGAS. Individuals were matched for demographic and health-related variables, which included history of cardiovascular disease, diabetes, and obesity. OUTCOMES: The main focus was to establish the rates and changes in psychiatric comorbidities following GGAS. RESULTS: Among individuals with GI, the study identified 4061 with GGAS and 100 097 without. At 1 year post-GGAS, there was a significant decrease in depression (odds ratio [OR], 0.748; 95% CI, 0.672-0.833; P < .0001), anxiety (OR, 0.730; 95% CI, 0.658-0.810; P < .0001), substance use disorder (OR, 0.730; 95% CI, 0.658-0.810; P < .0001), and suicidality (OR, 0.530; 95% CI, 0.425-0.661; P < .0001), and these reductions were maintained or improved on at 5 years, including posttraumatic stress disorder (OR, 0.831; 95% CI, 0.704-0.981; P = .028). CLINICAL IMPLICATIONS: The findings indicate that GGAS may play a crucial role in diminishing psychiatric comorbidities among individuals with GI. STRENGTHS AND LIMITATIONS: This is the largest known study to evaluate the effect of GGAS on psychiatric comorbidities in the GI population, offering robust evidence. The reliance on the precision of CPT and ICD-10 codes for data extraction poses a limitation due to potential coding inaccuracies. CONCLUSION: The evidence suggests a significant association between GGAS and reduced psychiatric comorbidities in individuals with GI.

Electric Scooter-related Injuries Are Becoming More Frequent and Costly in Denver, CO.

BACKGROUND: Electric scooters (e-scooters) have become a widely adopted form of transportation. Information regarding the timing, conditions, and context associated with increased frequency of e-scooter-related injuries could inform policy that may potentially reduce associated injuries and healthcare costs. However, this information is lacking, as most research to date has focused on the injury patterns sustained while using e-scooters rather than context. We sought to evaluate these factors in an urban setting and describe how these are evolving over time, as such information may help guide future safety initiatives. QUESTIONS/PURPOSES: (1) How has the epidemiology of e-scooter-related injuries in Denver, CO, USA, changed over time? (2) What are the associated hospital charges to treat patients with these injuries? (3) What circumstances are associated with an increased frequency of e-scooter-related injuries and higher accompanying hospital charges? METHODS: A retrospective study at a Level 1 trauma center in Denver, CO, USA, examined trends in e-scooter-related injuries from January 1, 2020, to November 1, 2023. Patients were identified by the key terms "e-scooter crash" or "scooter" within their emergency department/urgent care visit notes. Patient demographic and injury characteristics and hospital data (admission and hospital charges) were analyzed. Patients who sustained injuries from devices other than stand-up e-scooters or who did not have complete records available for analysis were excluded. The epidemiologic data on e-scooter-related injuries were quantified for each year within the study period, and descriptive analyses were performed to assess patient and injury characteristics, including age, gender, and fracture characteristics. Hospital charges were calculated using the mean annual sum of hospital charges associated with the treatment for e-scooter-related injuries. Circumstances influencing the frequency of injury and magnitude of hospital charges were assessed based on the timing of presentation to the emergency department or urgent care. We recognize that charge may have little or no direct relationship to true cost, but we believe that within one hospital system it represents a reasonable metric for comparative resource utilization. Injury frequency by time of the day and day of the week were compared using chi-square goodness-of-fit analyses. The value of hospital charges associated with e-scooter-related injuries was compared between patients presenting with alcohol intoxication and those who were not intoxicated. RESULTS: In all, 2424 patients were identified as having e-scooter-related injuries (58% [1405] men, 42% [1019] women, median (IQR) age 30 years [25 to 37 years]). The number of annual e-scooter-related injuries during the years 2020 to 2023 were 273 in 2020, 736 in 2021, 758 in 2022, and 657 in 2023 (only 10 months). From 2020 to 2023, the mean annual sum of hospital charges for treatment of e-scooter-related injuries was USD 10.4 million; USD 6.4 million in 2020, USD 11.5 million in 2021, USD 11.9 million in 2022, and USD 10.9 million in 2023 (only 10 months). Hospital charges associated with orthopaedic e-scooter-related injuries amounted to a mean annual sum of USD 3.6 million over the 4-year study period; USD 1.5 million in 2020, USD 3.9 million in 2021, USD 4.5 million in 2022, and USD 4.1 million in 2023 (only 10 months). Forty-five percent (1098) of all e-scooter-related injuries occurred between 7 PM and 3 AM, and 44% (1064) of them occurred over the weekend. The treatment of e-scooter-related injuries incurred higher hospital charges if injuries occurred during night hours (median [IQR] USD 10,459 [4779 to 16,423]) compared with early morning (USD 4973 [1178 to 11,671]) or daytime hours (USD 4871 [1059 to 11,673]; p < 0.001), or while patients were intoxicated (USD 13,404 [10,346 to 22,525]) compared with those who were not intoxicated (USD 6132 [2612 to 13,620]; p < 0.001). CONCLUSION: E-scooter-related injuries are increasing in frequency and occur most commonly during nighttime and weekend hours. Total hospital charges to treat these injuries are also increasing annually, with the highest charges observed during evening hours and in patients presenting with alcohol intoxication. These results may help inform e-scooter awareness initiatives and policy reform to place restrictions on e-scooter use during periods of highest injury frequency and healthcare charges. Further research related to the efficacy of implementing e-scooter restrictions is needed. Future observational studies evaluating time of injury compared with presentation for treatment could help to provide a more precise understanding of the epidemiology of these injuries. LEVEL OF EVIDENCE: Level IV, prognostic study.

The Effects of Body Mass Index on Postoperative Complications in Patients Undergoing Autologous Free Flap Breast Reconstruction.

BACKGROUND: The prevalence of obesity in the United States exceeds 40%, yet perioperative effects of higher body mass index (BMI) in autologous breast reconstruction remain poorly studied. The purpose of this study was to investigate BMI's impact on postop complications in abdominal and gluteal-based autologous breast reconstruction. METHODS: We conducted a retrospective study using TriNetX, a health care database containing de-identified data from more than 250 million patients. Patients undergoing autologous breast reconstruction were identified by Current Procedural Terminology codes. Four cohorts were established by BMI class: <24.99, 25 to 29.99, 30 to 34.99, and 35 to 39.99 kg/m2. Outcomes of interest were defined by International Classification of Diseases,Tenth Revision (ICD-10) codes. A two-sample t-test was performed to compare incidence of postoperative complications between cohorts within 3 months of surgery. Patients with a BMI < 24.99 kg/m2 served as the control. Cohorts were balanced on age, race, and ethnicity. RESULTS: We identified 8,791 patients who underwent autologous breast reconstruction. Of those, 1,143 had a BMI < 24.99 kg/m2, 1,867 had a BMI of 25 to 29.99 kg/m2, 1,396 had a BMI of 30 to 34.99 kg/m2, and 559 had a BMI of 35 to 39.99 kg/m2. Patients with a BMI of 25 to 29.99 kg/m2 had a significantly increased risk of cellulitis. Patients with a BMI of 30 to 34.99 and 35 to 39.99 kg/m2 had a significantly increased risk of cellulitis, surgical site infection, need for debridement, wound dehiscence, and flap failure. CONCLUSION: Our study illustrates that there is an increased risk of postoperative complications associated with higher BMI classes. Understanding these data are imperative for providers to adequately stratify patients and guide the procedural decision-making.

Trends in Gender-Affirming Surgeries in the United States from 2010 to 2021.

Introduction: In 2017, an estimated 1.6 million adults and 150,000 teenagers identified as transgender in the United States. With ever-changing legislative developments regarding health care benefits for this population and the increasing number of patients presenting for gender-affirming surgery (GAS), there is a scarcity of literature on the temporal trends within the past decade. The objective of this study was to examine the temporal trends of the utilization of GAS. Methods: We conducted a cross-sectional study using TriNetX, a federated research network containing deidentified aggregate patient data. Using International Code of Disease (ICD) and Current Procedural Terminology (CPT) codes, we identified patients with a diagnosis of gender dysphoria who underwent GAS from 2010 to 2021. Basic demographic information and complications were analyzed. Complications of interest included site failure, infection, and systemic complications. Results: We identified a total of 8,403 patients who underwent GAS between January 2010 and December 2021. The number of procedures per year increased nearly 500% between 2016 and 2021 from 421 procedures to 2,224 procedures. Our demographic results were consistent with previous survey-based studies. The average age of patients who underwent masculinizing surgeries was consistently younger than those who underwent feminizing surgeries. Most patients undergoing GAS were of white race. The overall complication rate was 4.7%. Conclusion: In conclusion, our study reveals a significant and rapid rise in the utilization of GAS in the United States, with a fivefold increase in procedures between 2016 and 2021. The demographic characteristics and low complication rates observed highlight the evolving landscape of health care for transgender individuals and the need for ongoing assessment and support in this field.

Analysis of Complications in Patients With a History of Cannabis Use and Tobacco Use Undergoing Implant-Based Breast Reconstruction.

BACKGROUND: There is limited information regarding the perioperative effects of marijuana in breast reconstructive surgeries. OBJECTIVES: The objective of this study was to explore the association between a history of cannabis use and postoperative complications in the setting of implant-based breast reconstruction. METHODS: Two databases, TriNetX and PearlDiver, were queried for patients undergoing implant-based breast reconstruction. Patients were divided into 4 groups based on active ICD-10 diagnostic codes: (1) cannabis use only, (2) tobacco use only, (3) cannabis and tobacco use, and (4) neither cannabis nor tobacco use. Associations with postoperative complications were analyzed with a logistic regression test. RESULTS: TriNetX search revealed that 327 patients had an active diagnosis of cannabis use only and 1118 had an active diagnosis of tobacco use only. Patients in the cannabis only cohort had a significantly increased risk of developing surgical site infection. Patients in the tobacco only cohort had significantly increased risk of developing wound dehiscence, need for debridement, and surgical site infection. The PearlDiver search included 472 patients who had an active diagnosis of both cannabis and tobacco use and 17,361 patients with a diagnosis of tobacco use only. Patients with a diagnosis of cannabis and tobacco use had a significantly increased risk of developing postoperative complications including surgical site infection, wound dehiscence, need for incision and drainage, and debridement. CONCLUSIONS: Patients undergoing implant-based breast reconstruction with an active diagnosis of cannabis with or without tobacco use were at increased risk of developing postoperative complications, and the risk was even higher in patients using both tobacco and cannabis.

Patient Outcomes following Septoplasty in Patients with Attention-deficit/Hyperactivity Disorder.

Recent research has indicated that daytime manifestations of sleep-disordered breathing, frequently caused by deviated septum, can mimic many characteristic symptoms of attention-deficit/hyperactivity disorder (ADHD) and could indicate intermittent hypoxia or hypercarbia as factors in the development of ADHD. To investigate the differences in outcomes following septoplasty between patients with ADHD and deviated septum, we used a retrospective cohort design to compare outcomes in patients diagnosed with deviated septa between June 1, 2002 and June 1, 2022. We then separated these patients into four total groups based on the presence or absence of ADHD diagnosis and the presence or absence of septoplasty. After matching cohorts to create insignificant differences in age, sex, and race, we analyzed various outcomes associated with ADHD, such as conduct disorders, anxiety disorders, fractures, and substance abuse disorders. Septoplasty reduces the risk for nearly all outcomes in patients with deviated septum, with statistically significant results present in 11 of 15 outcomes in both ADHD and non-ADHD groups. The effect of septoplasty was up to 10 times greater for the ADHD cohort. Patients with ADHD who receive septoplasty display a plethora of beneficial effects, with significantly reduced risk of common sequelae such as depression, obsessive-compulsive disorder, anxiety, and addictive disorders. The difference in outcomes indicates future prospective studies into outcomes of septoplasty in patients with ADHD.

Comorbid Conditions and Complications in Body Contouring Surgery: A Retrospective Review.

Background: Body contouring procedures have significantly increased in popularity in the United States. Objectives: The authors sought to understand, categorize, and classify patients' experiences with postoperative complications following common body contouring procedures. Methods: PearlDiver (PearlDiver Technologies, Colorado Springs, CO), a database with over 90 million patients, was queried to identify patients who had undergone body contouring procedures between 2010 and 2021 using current procedural terminology (CPT) codes. The authors identified patients who underwent panniculectomy, abdominoplasty, brachioplasty, thighplasty, mastopexy, breast augmentation, augmentation mastopexy, breast reduction, and liposuction for analysis. They reviewed combined procedures and analyzed risk factors associated with the most common complications. Results: There were 243,886 patients included in the study. The majority of patients were female, between 50 and 59 years old, and had their procedures performed in the southern United States. There were an average of 25,352 procedures per year. The majority of cases involved breast surgeries. The most common preoperative comorbid conditions diagnosed 1 year before surgery were hypertension, obesity, and diabetes. The most common postoperative complications within 90 days were wound dehiscence, hematoma, and urinary tract infection. A logistic regression evaluating the association of the preoperative comorbid conditions with postoperative complications found that patients with obesity, tobacco use, diabetes, and hypertension had an increased risk of developing wound dehiscence, hematoma, and surgical-site infection. Conclusions: The data suggest that patients with obesity, tobacco use, diabetes, and hypertension undergoing body contouring surgery are at greater risk of developing wound dehiscence, hematomas, and surgical-site infections. Understanding this data is imperative for providers to adequately identify associated risk factors, stratify patients, and provide adequate perioperative counseling.