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Implementation Of An Enhanced Recovery After Surgery Protocol For Facial Feminization Surgery Reduces Pain, Opioid Usage, And Length Of Hospital Stay
Meiwand Bedar, MD, Msc, Dillon Dejam, BS, Rachel M. Caprini, BS, Kelly X. Huang, HSD, Justine C. Lee, MD, PhD.
Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.

PURPOSE: Patients undergoing gender-affirming surgeries represent a potentially vulnerable cohort for prolonged opioid use. In addition to gender dysphoria, transgender patients are frequently diagnosed with anxiety or depression, known risk factors for persistent opioid use after surgery. This study evaluates the implementation of an enhanced recovery after surgery (ERAS) protocol to reduce opioid use after facial feminization surgery (FFS).
METHODS: 59 patients (mean age 32.510.3 years) who underwent single-stage facial feminization surgery before and after ERAS implementation were reviewed retrospectively. Patient characteristics, length of surgery, complications, pain scores, opioid use in morphine equivalent dosing per kilogram (MED/kg), and length of hospital stay were compared between groups.
RESULTS: Of the entire cohort, 67.4% of patients had a mental health diagnosis in addition to gender dysphoria, of which anxiety and depression were the most common. Comparison of the pre-ERAS (n=38, 64.4%) versus the ERAS (n=21, 35.6%) groups demonstrated no differences in age, body mass index, mental health diagnoses, length of surgery, or complications. The ERAS group reported lower postoperative pain scores (2.561.66 versus 3.711.57, p=0.01) and total inpatient opioid usage (1.020.41 versus 1.831.48 MED/kg, p=0.02) compared to pre-ERAS patients. The length of hospital stay was also reduced by an average of 8 hours in the ERAS group compared to the pre-ERAS group (31.810.0 versus 40.915.6 hours, p=0.02).
CONCLUSION: We report the design of the FFS ERAS protocol and demonstrate that implementation reduced pain scores, opioid use, and length of hospital stay after facial feminization surgery.


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