(473) Simultaneous Multidisciplinary Gender Affirming Surgery during COVID-19: Improving Access to Care for Military Patients

Abstract

Abstract Introduction Access to surgical care for the transgender population has been a persistent challenge. Frequently cited barriers include long waiting lists, strict insurance prior authorization protocols, surgeon scarcity, financial cost, and social stigma. These issues have been magnified throughout the COVID-19 pandemic response, as the diversion of resources has led to the postponement of surgeries deemed “routine” or “non-essential.” Many medical societies and healthcare organizations have classified gender-affirming surgery (GAS) as such despite the World Professional Association for Transgender Health (WPATH) defining surgical care for gender dysphoric individuals as medical necessity. Unfortunately, delays in care for this population contribute to prolonged mental health distress. Another important barrier to access centers on the issue of surgical timing. Many patients cannot afford to postpone school and work obligations to undergo multiple surgeries each with long recovery times. Furthermore, staffing shortages nationwide have limited operating room (OR) availability. To respond to these issues, our center organized a multidisciplinary collaboration among various surgical subspecialties to perform simultaneous GASs (e.g., top and bottom surgeries). In this way, the patient can undergo multiple GASs in a single procedure, thus limiting anesthesia exposure, expediting postoperative recovery, improving patient satisfaction and maximizing limited healthcare resources. Objective To describe a multidisciplinary model for GAS involving simultaneous top and bottom surgery to improve access to care for the transgender population in a resource-limited environment. Methods Case report describing successful multidisciplinary surgical management of a transgender female desiring multiple simultaneous GAS. Results Patient is a 24-year-old active duty transgender female who met WPATH criteria for top and bottom surgery. She desired numerous procedures including simple orchiectomy, breast implants and facial feminization. Given our limited OR availability during COVID-19, the decision was made to perform all of these surgeries under the same anesthetic. She underwent breast augmentation and fat harvesting with plastic surgery, which was immediately followed by simultaneous simple orchiectomy by urology and facial feminizing surgery with otolaryngology. Total operative time was 8.3 hours. Patient was discharged on post-op day 1 and had an uneventful recovery without surgical or anesthetic complications. Conclusions Simultaneous GAS is an effective approach to improve access to care during the COVID-19 pandemic. A single anesthetic enables the patients to achieve their surgical goals sooner and to lessen their overall recovery time compared to staged procedures. Disclosure No