(347) A Single Center Review of Access to Gender Affirming Surgical Care: Analysis of Consultation to Surgery Conversion Rates and Patient Wait Times
Authors: Arteaga R , Perez M , Chwa E , Hackenberger P , Beach L , Chaudhari A , Bowen D , Jordan S 
Published: February 2024

Abstract

Introduction
The demand for gender-affirming surgical care has grown exponentially throughout the United States throughout the last decade. Even within gender care programs, patients face complex barriers to receiving multidisciplinary, gender-affirming care. The differences in access to care among different gender-affirming procedures remain understudied. Understanding the barriers that patients face within our multidisciplinary gender care program is imperative to addressing the needs of our population.

Objective
To assess the differences in wait times and successful completion of surgery following initial consultation across multiple gender-affirming surgical procedures.

Methods
Records of all patients seeking an initial consultation for gender-affirming surgical care at a single center from February 2018 to March 2022 were reviewed. Recorded demographic data of patients included age, sex assigned at birth, gender identity, insurance type, race, and ethnicity. We categorized gender-affirming surgical care into the following procedures: vaginoplasty, phalloplasty, mastectomy, breast augmentation, facial feminization, orchiectomy, hysterectomy, and other. The conversion rate was defined as the percentage of patients who completed surgery after an initial consult. Patients were followed until April 2023, a minimum of &gt;365 days. Contact to consult was defined as the time between a patient’s initial contact for scheduling an appointment and a formal in-office consult, and consult to surgery was determined by the time from the first consult to the actual surgery. Comparisons were analyzed in SPSS with Pearson chi-square test or one-way ANOVA with post-hoc comparisons as appropriate.

Results
Our comprehensive gender care program conducted 621 consultations and 438 surgeries between February 2018 and March 2022. The difference between conversion rates among surgeries was statistically significant by Pearson chi-square test (p &lt;0.001), with vaginoplasty and phalloplasty having the lowest conversion rate at 31%, with post-hoc adjusted residuals &lt; -2. Facial feminization and mastectomy had a higher conversion rate (88% and 79%, respectively). Regarding time between major events, the time from patient contact to in-office consult was not statistically significant with one-way ANOVA between gender-affirming procedures at p= 0.53. However, the time from consult to surgery was statistically significant between groups at p= 0.002. Phalloplasty had a statistically longer consult to surgery time at 416 days (p&lt;0.02) than any other surgery on post-hoc testing. Vaginoplasty had a statistically lengthier wait at 289 days (p&lt;0.05) than mastectomy and breast augmentation.

Conclusions
Phalloplasty and vaginoplasty have the lowest conversion rates of all gender-affirming procedures. Among patients who undergo a phalloplasty, the consult to surgery wait time is statistically longer than any other surgery. For vaginoplasty patients, the consult to surgery wait is statistically longer than for mastectomy and breast augmentation. The differences in conversion rates and wait times from consult to surgery raise questions about disparities and access to care, particularly for more complex gender-affirming surgical procedures, that will be further explored in the dataset.

Disclosure
No.