
==== Front
Plast Reconstr Surg Glob Open
Plast Reconstr Surg Glob Open
GOX
Plastic and Reconstructive Surgery Global Open
2169-7574
Lippincott Williams & Wilkins Hagerstown, MD

GOX-D-24-00774
00002
10.1097/01.GOX.0001063816.42569.9a
3
PSTM Abstract Supplement
PSTM Top Abstracts/Posters 2024
Assessing Racial Inequalities in Gender-Affirming Genital Surgery: A Review of National Inpatient Data
Shamamian Peter Jr BS 1
Kwon Daniel BS 1
Oleru Olachi MD 1
Seyidova Nargiz MD, MHQS 1
Suydam Rebecca BA 1
Montalmant Keisha MD, MPH, MBA 1
Wang Carol BA 1
Taub Peter MD, MS 1
Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery
9 2024
18 9 2024
12 Suppl 1Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

OPEN-ACCESSTRUE
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pmcINTRODUCTION: Racial and ethnic minority groups have historically had more difficulty in accessing healthcare. They have also had worse experiences interacting with the healthcare system. Access issues often stem from structural inequalities, financial difficulties, discrimination, and geography. Beyond race and ethnicity, gender identity often complicates healthcare access and equality for many patients, particularly for patients who identify as transgender and may be seeking gender-affirming surgery. The intersection of these two areas of healthcare inequality may result in deficient healthcare for patients of minority racial and ethnic groups seeking gender-affirming care and surgery. Using a large national inpatient dataset, the present study sought to explore differences in gender-affirming genital surgery characteristics and safety measures by race.

METHODS: The 2019 Healthcare Utilization Project (HCUP) National Inpatient Survey (NIS) was queried using previously published gender dysphoria ICD-10-CM codes for selected gender-affirming genital surgeries, including vaginoplasty and phalloplasty. Demographics, including race, age, insurance payer, discharge status, and median income for patients were collected. Hospital-level and inpatient safety characteristics were also collected, including bed size, teaching status, for-profit status, region, length of stay, pre-existing comorbidities, and inpatient medical complications. Results were stratified by race and evaluated for significant differences using univariate analysis. Statistical significance was set at p<0.05.

RESULTS: A total of 1260 patients were included in the present study. The cohort identifying as White represented 67.5%, while 9.1% were Hispanic or Latino, 5.6% were Black or African American, and 3.1% were Asian or Pacific Islander. After stratification of variables by race, significantly fewer Black patients had a routine discharge (64.3%, p<0.001), and significantly more Hispanic/Latino patients left against medical advice (4.3%, p=0.047). Mean length of stay was significantly longer among Black patients (5.21 days, p=0.033). Mean total charges were highest among Black patients ($199,651, CI $90,216-$309,085, p<0.001). Finally, Black patients experienced significantly more inpatient medical complications (14.3%, p<0.001).

CONCLUSIONS: While the healthcare population is becoming more diverse, healthcare disparities still exist among non-White individuals receiving gender-affirming genital surgery. These non-White individuals experience significantly more challenges when attempting to receive care, which is further complicated by the United States’ policy landscape. Future studies will analyze more historical and recent data to assess trends at this intersection.
