Dedicated to the acceptance, medical treatment, & legal protection of individuals in the process of correcting the misalignment of their anatomical sex, & supporting their transition into society.
Choosing A Surgeon. Planning for a sex change involves an assessment of surgical options for Sex Reassignment Surgery (SRS — aka GRS) and quite possibly a variety of other related surgical procedures.
The doctors and surgeons you consider should fit at least these basic criteria:
2. The doctor is an active member of medical societies that relate to her or his specialty, and those with missions for public safety, ethics and excellence in practice. See the American Society of Plastic Surgeons (ASPS).
3. The doctor practices exclusively in the specialty in which he or she holds board certification. For example, there is no requirement that a doctor have any training or experience to purchase breast implants and surgically place them into your body. Certification is important.
4. The doctor listens to your concerns and answers your questions directly. The focus is on you.
5. The doctor has performed the procedure you are interested in (e.g., SRS) many times and can provide recent before-and-after photographs of actual patients. The doctor should explain the outcomes and how they were achieved.
6. The doctor performs all procedures that require more than a local (topical) anesthetic in accredited or licensed office-based, ambulatory or hospital surgical facilities. The doctor should clearly define the anesthesia you will have and the credentials of the person charged with its administration.
7. The doctor has privileges at a local accredited hospital facility to perform the specific surgical procedure you are considering. If a local hospital has barred the doctor to perform surgery on hospital property, do not consider letting this doctor perform surgery on you.
8. The office is clean and orderly. The staff is respectful of your time and presence. The attention you get should be consistent. Your privacy is respected. You should feel safe and welcomed.
9. You have checked with the applicable state medical board and the doctor is licensed to practice in the state. There should be no prior or pending actions against her or him. Lawsuits are frequent but only actual negligence can jeopardize the status of a doctor’s medical license.
10. You are comfortable with the doctor and willing to place your life in her or his hands.
St. Louis, MO, USA. In most situations where society imposes strict standards for product or service quality, consumers can tolerate some level of error, however minute. Patients attitudes about surgery are not so forgiving. An incision, a cut made in the body to perform surgery, is a site at obvious risk for infection. Surgical facilities can go to great lengths in an attempt to preempt infections. Performed correctly, operating teams scrub their hands, wear sterile gloves, prepare the surgical site, and use sterile instruments.
But what constitutes an acceptable outcome? A surgical site infection (SSI) can be painful, expensive, and leave possible disfigurations. Despite the preparations, patients still experience infections.
Hospital-Associated Costs Due to Surgical Site Infection After Breast Surgery. Margaret A. Olsen; Sorawuth Chu-Ongsakul; Keith E. Brandt; Jill R. Dietz; Jennie Mayfield; Victoria J. Fraser. Archives of Surgery. 2008;143(1):53-60.
A new report in the Archives of Surgery says that infections at the incision site occurred in more than 5 percent of patients following breast surgery and cost them more than $4,000 each in hospital-related expenses. “Given the state of fiscal constraints within the U.S. health care system, it is important to calculate the cost-effectiveness of infection control interventions to justify their use from an economic perspective,” the authors write.
Reported surgical site infection rates following mastectomy (surgical removal of the breast) and other breast procedures range from 1 percent to 28 percent. According to background information in the article, “Cost-effectiveness analyses require accurate estimates for the attributable costs of hospital-acquired infections, which are lacking for surgical site infections.” [Also, review a discussion of the invited journal critique at the end of this article.]
Margaret A. Olsen, Ph.D., M.P.H., of the Washington University School of Medicine (St. Louis) and colleagues studied 949 hospital admissions for mastectomy or breast reconstruction procedures at a university-affiliated hospital between 1999 and 2002. Surgical site infections were identified in an electronic hospital database and verified by review of medical records. Costs were taken from the hospital accounting database and included those from the original admission to the hospital for surgery as well as any readmissions within one year of surgery.
Surgical site infections were identified in 50 women within one year of surgery (5.3 percent). Infections were more common in patients undergoing cancer-related procedures, and occurred following 12.4 percent of mastectomies with immediate breast reconstruction using an implant; 6.2 percent of mastectomies with immediate breast reconstruction using abdominal tissue; 4.4 percent of mastectomies only and 1.1 percent of breast reduction surgeries. The average time between surgery and infection diagnosis was 46.6 days.
“Patients with surgical site infections had significantly higher hospital costs associated with surgery and during the one-year period after surgery compared with uninfected patients, and they had a significantly longer total length of hospital stay,” the authors write. After adjusting for the type of surgical procedure performed, breast cancer stage and other variables that influence cost, the cost of surgical site infections was $4,091 per patient.
“Potential interventions to reduce the incidence of surgical site infections in this patient population include strategies to optimize the timing and dosage of prophylactic antibiotics administered before the surgical incision, glucose control in diabetic patients, promotion of meticulous hand hygiene and strategies to promote timely removal of drains, among others,” the authors conclude. “Interventions to reduce the incidence of surgical site infections following breast cancer surgical procedures are essential to reduce not only morbidity in these patient populations but also costs to the individuals and to society.”
An invited critique of this research by by Kelly K. Hunt, MD (Arch Surg. 2008;143(1):61.) says that "Mastectomy infection rates have been reported by the Centers for Disease Control and Prevention to be 2%, but references cited by Olsen and colleagues report rates from 2.8% to 25%." Doctor Hunt explains the variance, noting that certain of the referenced studies are more than a decade old and wonders if the data are relevant in the current practice environment. Hunt says "Patients undergoing breast cancer surgery today are most often treated on an outpatient basis, with drains in place for only a few days".
However, most of the observed variances might be explained by differing data collection methods and the time delay inherent when evaluating followup data from contemporary hospital incident reports.
Hospital-Associated Costs Due to Surgical Site Infection After Breast Surgery. Margaret A. Olsen; Sorawuth Chu-Ongsakul; Keith E. Brandt; Jill R. Dietz; Jennie Mayfield; Victoria J. Fraser. Archives of Surgery. 2008;143(1):53-60.
Abstract
Objective. To determine the attributable costs associated with surgical site infection (SSI) following breast surgery.
Design and Setting. Cost analysis of a retrospective cohort in a tertiary care university hospital.
Patients. All persons who underwent breast surgery other than breast-conserving surgery from July 1, 1999, through June 30, 2002.
Main Outcome Measures. Surgical site infection and hospital costs. Costs included all those incurred in the original surgical admission and any readmission(s) within 1 year of surgery, inflation adjusted to US dollars in 2004.
Results. Surgical site infection was identified in 50 women during the original surgical admission or at readmission to the hospital within 1 year of surgery (n = 949). The incidence of SSI was 12.4% following mastectomy with immediate implant reconstruction, 6.2% following mastectomy with immediate reconstruction using a transverse rectus abdominis myocutaneous flap, 4.4% following mastectomy only, and 1.1% following breast reduction surgery. Of the SSI cases, 96.0% were identified at readmission to the hospital. Patients with SSI had crude median costs of $16 882 compared with $6123 for uninfected patients. After adjusting for the type of surgical procedure(s), breast cancer stage, and other variables associated with significantly increased costs using feasible generalized least squares, the attributable cost of SSI after breast surgery was $4091 (95% confidence interval, $2839-$5533).
Conclusions. Surgical site infection after breast cancer surgical procedures was more common than expected for clean surgery and more common than SSI after non–cancer-related breast surgical procedures. Knowledge of the attributable costs of SSI in this patient population can be used to justify infection control interventions to reduce the risk of infection.
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Richard Smith, Editor-in-Chief, introduces Cases Journal. Dr. Smith urges all physicians to submit their case reports to the new open access Cases Journal, which publishes case reports from any area of healthcare.
Cases Journal will publish any case report that is understandable, ethical, authentic, and includes all essential information. A more selective companion, the Journal of Medical Case Reports, publishes original and interesting case reports that contribute significantly to medical knowledge. Article submissions are subject to potential publication by either journal. All reports will be entered in a common and open access database.
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