Complication rates in gender affirming surgeries are affected by many factors, including the surgery itself, the health status of the patient and the patient’s resources to comply with aftercare instructions, the surgeon’s skill and knowledge, the anesthesiologist’s skill and knowledge, the equipment and procedures at the surgical facility, and the skill and knowledge of the pre-and post-operative care team. Oof, that’s a lot of safety measures to keep track of!
Patients do have some ability to lower their risk, either independently or by working with their care team: stopping smoking and drinking before surgery, getting good nutrition, stopping some medications before surgery, and managing diabetes and hypertension, if present, can reduce the risk of negative outcomes. So can keeping up with good nutrition and care plans after surgery. (More information on surgical risks is in our BMI and Surgery blog.)
Some risks are not directly affected by the patient but can be researched, like complication rates and safety information for your surgical facility and surgeon. Here’s how to look up information about:
- Hospital Safety Measures
- Joint Commission Accreditation
- Surgeon Board Certification
The below tools can help you compare facilities for overall safety and confirm that your surgeon has maintained their skills, knowledge, and membership in the organization tasked with monitoring baseline skill sets and recognizing excellence.
Hospital Safety Measures
There are a lot of safety surveys and measurements, but not many ways to find out how hospitals actually score. Here are some tools for finding out more about your facility:
Leapfrog Hospital Safety Grade
Leapfrog Ratings – this may be the most comprehensive set of information available for patients.
Enter your facility’s name in the search box to see the results.
Overall Grade and comparison to other hospitals: scroll to the bottom of the page and click on “See facility’s Safety Grade”.
See how your hospital compares to others in several patient safety measures. Note: hospitals that are major trauma centers may have worse rates than other hospitals that see fewer very sick people. How green is your facility?
Here are some of the measures important to gender affirming surgeries, especially bottom surgeries. Note – we’re using their category headings and terminology!
Infections: Infection in the Urinary Tract, Surgical site infection after colon surgery, Sepsis infection after surgery.
Problems with Surgery:
- Surgical wound splits open (dehiscence) – this is a common complication after gender affirming surgeries.
- Serious breathing problem – pneumonia after surgery is a serious complication.
- Accidental cuts and tears.
Safety Problems:
- Harmful events – any complication.
- Dangerous blood clot – blood clots after surgery and extended bed rest are serious complications. If your hospital has a poor score, consider asking about their preventive measures such as blood thinning medication, compression garments, and getting patients out of bed and walking around after surgery.
Practices to Prevent Errors:
- Electronic medication ordering – less likely to have complicated medicine regimens after gender affirming surgery
- Safe medication administration
- Handwashing – infection control!
- Communication about Medicines
- Communication about Discharge – aftercare is vital in gender affirming surgeries. Look for the green.
- Staff work together to prevent errors
Doctors, Nurses & Hospital Staff:
- Enough qualified nurses
- Communication with Doctors
- Communication with Nurses
- Responsiveness of Hospital Staff
Back on the main report page, access details about additional safety measures:
- Patient-Centered Care – patient experiences in billing, informed consent, and when things go wrong.
- Preventing Patient Harm – mostly nursing-level safety practices.
- Critical Care – does the hospital have highly trained specialists on staff?
- Healthcare-Associated Infections – fewer infections are better.
- (wording alert) Maternity Care – most measures are not applicable to gender affirming care, but “Preventing Blood Clots in Women Undergoing Cesarean Section” may also inform their practices for preventing blood clots in bottom surgery patients.
- Medication Safety – important safety standards for care.
- Pediatric Care – not generally applicable.
- Complex Adult and Pediatric Surgery – not immediately applicable to gender affirming surgeries, but pay attention to the “Safe Surgery Checklist – Complex Surgery.” This is a measurement of how closely hospital staff perform a standardized safety checklist before surgeries.
- Total Joint Replacement – not generally applicable.
- Elective Outpatient Surgery – Adult: look for general safety information applicable to outpatient surgeries.
- Plastic and Reconstructive Surgery section has the total number of procedures performed annually for breast repair/reconstruction and skin grafts: do the surgeons do this type of procedure frequently?
- (Gendered Wording alert) Urology – statistics about some gender affirming procedures done at the facility might be included in this category.
- Elective Outpatient Surgery – Pediatric: not generally applicable.
- Care for Elective Outpatient Surgery Patients – general measures are applicable to surgeries without overnight stays.
The Joint Commission
The Joint Commission (JCAHO) is an organization that surveys medical facilities about their safety procedures and practices. The survey process for accreditation is intense: there is a ton of paperwork involved, and safety and quality experts from the Joint Commission arrive in person, usually without warning, to inspect and evaluate how closely the facility upholds scientifically supported standards of care. Earning gold seal accreditation is a pretty big deal. Institutions that perform satisfactorily on the survey receive JCAHO accreditation.
Accreditation isn’t just a yes/no answer: there are hundreds of measures that are looked at.
Unfortunately, QualityCheck.org does not provide information about each specific measure for each facility inspected. However, accreditation and earning top-performer status is an indicator of a medical facility that is serious about patient safety.
Is my facility accredited?
You can look up healthcare organizations for their Joint Commission status here.
For example purposes, I’m going to use a local Seattle, WA healthcare facility: the University of Washington Harborview Medical Center.
If accredited the facility will come up on the next page. It will list what programs are accredited, and if they earned distinction compared to other facilities (“Top Performer.”)
Click on “View Report” to bring up information about how they did when they were inspected. You can also look up their accreditation history. If accreditation was ever denied, you may want to dive deeper.
If you want to know more detail, ask the facility’s patient safety office for their Joint Commission reports on patient safety measures specific to surgical complications. This office might be called the patient relations office, or some other name. If in doubt, ask for the office that takes complaints (or praise!)
Are you a dataset nerd?
The Centers for Medicare & Medicaid Services publish multiple datasets on healthcare quality. NOTE: this is only data about procedures and hospitalizations paid for by Medicare and Medicaid. But if a surgeon or hospital has excellent safety rates for their Medicaid and Medicare patients, their private-pay patients likely also have good results.
Some very shiny datasets to dive into:
Filtered for Hospitals:
- CMS Medicare PSI-90: composite complication measure of 10 separate patient safety indicators for hospital-level quality.
- Complications and Deaths – Hospital
- Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey for ambulatory surgical centers – Facility
- Patient experiences of care in hospital outpatient departments and ambulatory surgical centers
- Patient Survey (PCH – HCAHPS) PPS – Exempt Cancer Hospital – Hospital
- Hospital ratings from patient surveys about inpatient stays
- Healthcare-Associated Infections – Hospital
- Infections that occur in the hospital
- Hospital-Acquired Condition (HAC) Reduction Program
- Scores for complications by hospital
Board Certification For Surgeons
Board certification is separate from having a medical license and measures their knowledge, skills, and dedication to maintaining their skills. Doctors take an initial exam to become board-certified and then repeat that exam regularly (and complete continued medical training.)
Is Your Surgeon Board-Certified?
Enter your surgeon’s name, location, and specialty to check if they are board-certified in their specialty.
There are 24 member boards that represent 40 specialties and 89 subspecialties for certification. A physician can be certified with multiple boards.
- Allergy and Immunology
- Anesthesiology
- Colon and Rectal Surgery
- Dermatology
- Emergency Medicine
- Family Medicine
- Internal Medicine
- Medical Genetics and Genomics
- Neurological Surgery
- Nuclear Medicine
- Obstetrics and Gynecology
- Ophthalmology
- Orthopedic Surgery
- Otolaryngology-Head and Neck Surgery
- Pathology
- Pediatrics
- Physical Medicine and Rehabilitation
- Plastic Surgery
- Preventive Medicine
- Psychiatry and Neurology
- Radiology
- Surgery
- Thoracic Surgery
- Urology
We hope this helps! A trustworthy surgeon will openly talk about the possible complications for any surgery, their experience with common complications, and what they do to prevent complications, and how to treat them if they do occur.
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