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Individuals undergoing gender-affirming surgery (GAS) with a pre-existing mental health condition seemed to face higher rates of postoperative complications, researchers reported.

In a study of more than 4,000 patients, those with an established diagnosis of a mental health condition had a higher chance of experiencing postoperative complications within 90 days of GAS versus those without a mental health condition, with absolute rates of 12.8% versus 8%, respectively (OR 1.43, 95% CI 1.15-1.79, P=0.002), according to Adán Z. Becerra, PhD, of Rush University Medical Center in Chicago, and colleagues.

A few other factors other than mental health also appeared to play into GAS postoperative complications, the authors noted in their research letter. For instance, Medicaid patients had 36% higher odds for complications versus those covered by commercial insurance (OR 1.36, 95% CI 1.03-1.78).

And those with an existing mental health condition plus Medicaid coverage experienced some of the highest rates of GAS postoperative complications (OR 1.82, 95% CI 1.09-3.21, P=0.03 for interaction), with a total of 14% of these patients experiencing a complication.

"These findings may point to inequities in social determinants of health and barriers to care, including follow-up care," Becerra's group said. "These patterns are further exacerbated among individuals covered by Medicaid."

Other factors associated with higher odds of complications were age (OR 1.09 for every 10-year increase, 95% CI 1.07-1.11) and Charlson Comorbidity Index (OR 1.16 for each 1-point increase, 95% CI 1.11-1.21).

In terms of procedure type, hysterectomy was associated with a higher odds of complications for people with an established mental health diagnosis (OR 1.40, 95% CI 1.07-1.81) while breast augmentation was associated with a lower likelihood (OR 0.61, 95% CI 0.43-0.85).

Procedure year, region of the U.S., as well as sex assigned at birth didn't appear to be factors linked with postoperative complications.

The cohort study included 4,318 patients with gender dysphoria who underwent GAS between 2011 to 2020 and appeared in the national all-payer PearlDiver Mariner database. Mental health conditions diagnosed within 1 year prior to surgery were included.

The most common GAS procedures were mastectomy (33.6%), breast augmentation (17.4%), hysterectomy (16.9%), and orchiectomy (9.9%). Almost one-fourth of patients had "other" procedures, such as phalloplasty and vaginoplasty.

Using billing codes, 90-day postoperative complications were identified, such as acute kidney injury, surgical site infection, deep venous thrombosis, pulmonary embolism, wound disruption, urinary tract infection, pneumonia, blood transfusion, hematoma, urethral stricture, urethral stenosis, and rectovaginal fistula.

A total of 2,641 patients had an established presurgical mental health condition diagnosis (61.2%), of which 339 experienced a postoperative complication within 90 days. Of the 1,677 patients without a prior mental health history (38.8%), 134 experienced a complication.

Becerra's group noted that it's likely that some of the patients had present but undiagnosed mental health conditions, potentially limiting the magnitude of the associations. "Providing appropriate resources to individuals undergoing GAS may help reduce the rate of postoperative complications and optimize outcomes," they suggested.

Another study limitation was that the researchers did not look at links with specific mental health conditions.

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