Safety and quality outcomes of same-day discharge for gender-affirming mastectomy during the pandemic.
The COVID-19 pandemic led to widespread postponement of elective procedures—including transplant, oncologic, and breast surgeries—prompting global expansion of ambulatory discharge pathways to preserve capacity and reduce exposure. However, the safety of this approach for transgender and gender-diverse (TGD) patients has not been well established. Gender-affirming mastectomy is a common procedure for TGD individuals, yet perioperative outcomes during the pandemic period remain poorly characterized. While several studies have examined ambulatory mastectomy in oncologic or reconstructive contexts, few have evaluated pandemic-era shifts in discharge practices or their implications for safety and patient experience in gender-affirming surgery. A retrospective review was conducted of 57 consecutive adults who underwent gender-affirming mastectomy at a single academic center from 2018 to 2021, spanning pre- and peri-pandemic periods. Primary outcomes included postoperative complications and unplanned health care utilization within 30 days (emergency department visit, reoperation, or patient-initiated call/message). Chart-documented misgendering (use of incorrect name or pronouns) was evaluated as a cultural complication. Forty-five patients (79%) were discharged the same day and 12 (21%) stayed overnight. Complications occurred in 2.2% of ambulatory vs. 8.3% of overnight cases, an absolute difference of 6% points. Although this difference did not achieve statistical significance (p = 0.38), the effect magnitude suggests a potential clinical signal that a larger, adequately powered study could better define. Unplanned emergency visits (8.9% vs. 16.7%, p = 0.60) and reoperations (0% vs. 8.3%, p = 0.22) showed similar directional patterns. Taken together, these trends indicate possible differences in postoperative trajectories that may be obscured by the limited power of the current analysis. Patient-initiated calls or messages occurred in 71.1% of ambulatory and 41.7% of overnight cases, suggesting possible differences in reassurance-seeking or access to remote communication. Misgendering appeared in 38.6% of charts overall and was more frequently documented among overnight patients (66.7% vs. 22.2%), an absolute difference of ≈ 45% points (p = 0.04). We conducted a retrospective cohort study examining perioperative outcomes during a period of restricted surgical volume associated with the COVID-19 pandemic. Within the inherent limitations of pandemic-era cohort size and inferential power, same-day discharge after gender-affirming mastectomy was implemented without clear evidence of increased short-term surgical complications or unplanned health care utilization. The trends observed in our patient population may nonetheless hold clinical relevance and warrant confirmation in larger, adequately powered studies. The higher frequency of documented misgendering among overnight patients underscores both the cultural and clinical dimensions of postoperative and psychological safety. Taken together, these findings suggest that ambulatory management is feasible and promising for appropriately selected transgender and gender-diverse patients, while emphasizing the need for multi-institutional research to better estimate effect sizes and to strengthen affirming communication practices across care settings.
