Health state utility values in patients undergoing chest masculinization surgery

Manraj N Kaur; Lucas Gallo; Yi Wang; Charlene Rae; Giancarlo McEvenue; John Semple; Natasha Johnson; Kinusan Savard; Andrea L Pusic; Devin Coon; Anne F Klassen

doi:10.1016/j.bjps.2023.02.004

Health state utility values in patients undergoing chest masculinization surgery

J Plast Reconstr Aesthet Surg. 2023 Jun:81:26-33. doi: 10.1016/j.bjps.2023.02.004. Epub 2023 Feb 9.

Authors

Manraj N Kaur¹, Lucas Gallo², Yi Wang³, Charlene Rae⁴, Giancarlo McEvenue⁵, John Semple⁶, Natasha Johnson⁴, Kinusan Savard⁷, Andrea L Pusic⁸, Devin Coon⁸, Anne F Klassen⁴

Affiliations

¹ Brigham and Women's Hospital, Harvard Medical School, 75 Francis S, Boston, MA 02116, USA. Electronic address: mkaur17@bwh.harvard.edu.
² Department of Surgery, Division of Plastic Surgery, McMaster University, 1280 Main Street W, Hamilton, ON, Canada L8N 3Z5.
³ Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, Canada L8N 3Z5.
⁴ Department of Pediatrics, McMaster University, 3N27, 1280 Main Street W, Hamilton, ON, Canada L8N 3Z5.
⁵ Doctor Giancarlo Plastic Surgery Clinic, 4600 Linton Blvd, Suite 310, Delray Beach, FL 33445, USA.
⁶ Division of Plastic Surgery, Women's College Hospital, 76 Grenville St, Toronto, ON, Canada M5S 1B2.
⁷ Fleming College, 599 Brealey Dr, Peterborough, ON, Canada K9J 7B1.
⁸ Brigham and Women's Hospital, Harvard Medical School, 75 Francis S, Boston, MA 02116, USA.

PMID: 37068381
DOI: 10.1016/j.bjps.2023.02.004

Abstract

Background: Chest masculinization surgery is the most common gender-affirming procedure performed in transgender and gender-diverse individuals. While evidence on the health-related quality of life (HRQL) impact of chest masculinization is starting to emerge, data on health state utility values (HSUVs) associated with the surgery is largely missing. The objectives of this study were to estimate the HSUVs using EQ-5D for patients seeking chest masculinization surgery and assess the determinants of EQ-5D score at 6 months postoperatively.

Methods: Patients seeking chest masculinization at a single community plastic surgery clinic by 2 surgeons completed 3 patient-reported outcome measures - EQ-5D-3L, Patient Health Questionnaire (PHQ)-9, and BODY-Q Chest module - preoperatively and postoperatively at 6 weeks and 6-months. Friedman test was used to assess the differences in PROM scores at the 3 timepoints. Simple and backward stepwise regression analyses of 6-month postoperative EQ-5D scores were performed.

Results: A total of 113 patients (mean [SD] age, 25.7 [6.9] years) were included. The mean [SD] EQ-5D scores at preoperative, postoperative 6 weeks and 6 months were 0.81 [0.15], 0.84 [0.15] and 0.87 [0.12], respectively. Postoperatively, problems were most frequently reported in the dimensions "pain/discomfort" and "anxiety/depression". Preoperative PHQ-9 score was a predictor of 6-month postoperative EQ-5D scores following simple (p < 0.01) and backward stepwise linear regression analysis (p < 0.01).

Conclusion: Chest masculinization was associated with an improvement in overall HRL at 6 months postoperatively; however, this did not achieve statistical significance. Preoperative depression severity was a significant determinant of postoperative HRL. Consequently, additional support must be offered to patients who have a higher level of preoperative depression.

Keywords: BODY-Q; Chest masculinization; Depression; EQ-5D; Patient-reported outcome measures; Quality of life.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Health Status
Humans
Pain
Quality of Life*
Regression Analysis
Surveys and Questionnaires
Thoracic Surgical Procedures*

Grants and funding

CIHR/Canada