An Enhanced Recovery after Surgery Protocol for Facial Feminization Surgery Reduces Perioperative Opioid Usage, Pain, and Hospital Stay

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2023-10, Vol.85, p.393-400
• Main Authors: Bedar, Meiwand, Dejam, Dillon, Caprini, Rachel M., Huang, Kelly X., Cronin, Brendan J., Khetpal, Sumun, Morgan, Katarina B.J., Lee, Justine C.
• Format: Article
• Language: English
• Subjects: Enhanced Recovery After Surgery Protocol; Facial Feminization Surgery; Gender-Affirming Surgery; Opioid Use; Tramadol
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2023.07.044

Prescription drug misuse in transgender individuals is estimated to be 3 times higher than that of the general population in the United States, suggesting that opioid reduction strategies deserve significant consideration in gender-affirming surgeries. In this work, we describe the implementation of an enhanced recovery after surgery (ERAS) protocol to reduce opioid use after facial feminization surgery. 79 patients who underwent single-stage facial feminization surgery before (n=38) or after (n=41) ERAS protocol implementation were included. Primary outcomes assessed were: perioperative opioid consumption (morphine equivalent dose/kilogram, MED/kg), average patient-reported pain scores, and length of hospital stay. Comparisons between groups and multivariable linear regression analyses were conducted to define the contribution of the ERAS protocol to each of the three primary outcomes. Age, body mass index, mental health diagnoses, and length of surgery did not differ between pre-ERAS and ERAS groups. Compared to pre-ERAS patients, patients treated under the ERAS protocol consumed less opioids (median[interquartile range, IQR], 0.8[0.5-1.1] versus 1.5[1.0-2.1] MED/kg, p