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Опрос хирургов оценивает сожаление после гендерной операции в 0,2–0,3% — на основе 30% ответов и воспоминаний хирургов

Направляя беседу: виды сожаления после гендерно-аффирмирующей операции и связанные с ними причины

ОпросыДетранзиция и сожалениеХирургия
Authors
Sasha Karan Narayan, Rayisa Hontscharuk, Sara Danker, Jess Guerriero, Angela Carter, Gaines Blasdel, Rachel Bluebond-Langner, Randi Ettner, Asa Radix, Loren Schechter, Jens Urs Berli
Journal
Annals of Translational Medicine
Year
2021
Source
https://doi.org/10.21037/atm-20-6204

Summary

Gender surgeons who attended WPATH and USPATH conferences (meetings of trans health professionals) were asked how many patients they had seen who regretted surgery or wanted it reversed. Fewer than a third replied. Together they recalled 62 such patients out of an estimated 18,000 to 27,000 they had operated on, so the authors put regret at 0.2–0.3%. Where reasons were known, the most common was a change in gender identity or a wrong diagnosis, then family or social rejection, then relationship problems. The authors suggest sorting regret into three types: 'true gender-related', 'social' and 'medical'. This grouping is useful for discussion. But the regret figure cannot be trusted: it depends on surgeons' memory, on regretful patients going back to a surgeon, and on numbers from a self-selected minority who answered.

Key findings

  • Ответили 46 из 154 приглашённых хирургов (30%); большинство работали в США (67%) или Европе (22%), а 65% практиковали более 10 лет.
  • Они оценили, что оперировали от 18 125 до 27 325 транс-пациентов, и вспомнили 62, сожалевших об операции или просивших об её обращении, около 0,2–0,3%.
  • 57% хирургов видели хотя бы одного пациента с сожалением; 45 из 62 случаев (73%) касались операций на половых органах и 13 (21%) — операций на груди.
  • Там, где причины были известны (46 пациентов), 42% касались изменения гендерной идентичности или неверного диагноза, 15% — отвержения семьёй или обществом и 11% — проблем в отношениях.
  • Авторы разделили просьбы об обращении на «истинное гендерное» сожаление (42%), «социальное» сожаление (37%) и «медицинское» сожаление (8%); у 24% этих пациентов были осложнения после операции.
  • 91% хирургов потребовали бы новой оценки психического здоровья перед обратной операцией, а 88% хотели, чтобы следующие руководства WPATH охватывали обратные операции.
  • Авторы признают, что опросы плохо подходят для определения того, насколько что-то распространено, и что их обзор прошлых исследований не был систематическим.

Abstract

Background: A rare, but consequential, risk of gender affirming surgery (GAS) is post-operative regret resulting in a request for surgical reversal. Studies on regret and surgical reversal are scarce, and there is no standard terminology regarding either etiology and/or classification of the various forms of regret. This study includes a survey of surgeons' experience with patient regret and requests for reversal surgery, a literature review on the topic of regret, and expert, consensus opinion designed to establish a classification system for the etiology and types of regret experienced by some patients.

Methods: This anonymous survey was sent to the 154 surgeons who registered for the 2016 World Professional Association for Transgender Health (WPATH) conference and the 2017 USPATH conference. Responses were analyzed using descriptive statistics. A MeSH search of the gender-affirming outcomes literature was performed on PubMed for relevant studies pertaining to regret. Original research and review studies that were thought to discuss regret were included for full text review.

Results: The literature is inconsistent regarding etiology and classification of regret following GAS. Of the 154 surgeons queried, 30% responded to our survey. Cumulatively, these respondents treated between 18,125 and 27,325 individuals. Fifty-seven percent of surgeons encountered at least one patient who expressed regret, with a total of 62 patients expressing regret (0.2-0.3%). Etiologies of regret were varied and classified as either: (I) true gender-related regret (42%), (II) social regret (37%), and (III) medical regret (8%). The surgeons' experience with patient regret and request for reversal was consistent with the existing literature.

Conclusions: In this study, regret following GAS was rare and was consistent with the existing literature. Regret can be classified as true gender-related regret, social regret and medical regret resulting from complications, function, pre-intervention decision making. Guidelines in transgender health should offer preventive strategies as well as treatment recommendations, should a patient experience regret. Future studies and scientific discourse are encouraged on this important topic.

Conclusion

In this study, regret following GAS was rare and was consistent with the existing literature. Regret can be classified as true gender-related regret, social regret and medical regret resulting from complications, function, pre-intervention decision making. Guidelines in transgender health should offer preventive strategies as well as treatment recommendations, should a patient experience regret. Future studies and scientific discourse are encouraged on this important topic.