Perioperative Estrogen Hormonal Therapy Does Not Increase Venous Thromboembolism Risk in Facial Feminization Surgery.

The overall VTE incidence in patients undergoing facial feminization surgery while continuing hormone therapy was 0.10%.

• Only 1 patient out of 953 meeting final inclusion criteria was diagnosed with a VTE postoperatively.
• This rate is described as 'comparable to reported literature rates for similar cosmetic and orthognathic procedures.'
• The study was a 38-year retrospective cohort study within a 2-surgeon practice.
• A total of 1715 patients underwent facial feminization surgery within the search window, of whom 953 met final inclusion criteria.

There was no significant difference in VTE incidence among the three subgroups defined by perioperative hormone management.

• 714 patients (77.7%) continued full-dose hormonal therapy perioperatively.
• 197 patients (20.7%) underwent hormonal dose reduction to 25% to 50% perioperatively.
• 8 patients were either not taking hormonal therapy or stopped in the perioperative period.
• P > 0.99 for difference in VTE incidence among the three subgroups.

The average Caprini score and average case length of the study population were quantified.

• The average Caprini score of all patients was 3.1 ± 1.0.
• The average case length was 491.9 ± 111.0 minutes.
• These values reflect the perioperative risk profile of patients undergoing facial feminization surgery.

Acute perioperative cessation of feminizing hormone therapy leads to unpleasant side effects and exacerbates gender dysphoria.

• This clinical consideration was identified as motivation for studying whether continuation of hormone therapy is safe.
• The authors note that conflicting data exist regarding increased perioperative VTE risk with feminizing hormone therapy.
• The effect of hormone therapy on VTE risk had been poorly studied within the transgender population prior to this study.

Continuing feminizing hormonal therapy through the time of facial feminization surgery was found to be reasonable based on the study findings.

• The study design was a retrospective cohort study spanning 38 years within a 2-surgeon practice.
• The evidence level was classified as Therapeutic, III.
• The authors concluded that perioperative use of feminizing hormonal therapy does not increase risk for perioperative VTE in this surgical population.