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• W4290930488 abstract "Extensive patient databases such as the American College of Surgeons National Surgical Quality Improvement Program are crucial for performing large-scale, multicenter analyses on surgical care. In 2020 alone, there were over 600 publications on PubMed that include “NSQIP.” Although the inclusion of patients from multiple institutions enhances external validity, application of these data in patient care presents unique challenges. Ethicists have warned of the potential for unintentional biases in data collection and presentation to reinforce existing sex/gender disparities.1 Using the National Surgical Quality Improvement Program as a representative example, our analysis uncovered significant ambiguity in coding for sex/gender variables, preventing accurate assessment for all sex-based procedures and significantly confounding transgender/nonbinary-focused analyses in particular. The American College of Surgeons asks participating institutions to combine sex and gender variables at the time of data input and allows for the assignment of only one of three options: male, female, or null. Limited guidance exists for inputting these data, creating institutional discretion and significant variability. This design truncates the spectrum of gender identity and has led to gross inaccuracies of basic demographic information. For example, the 2018 National Surgical Quality Improvement Program database contains 1074 patients diagnosed with transgender, transsexual, or gender identity disorder based on International Classification of Diseases codes. Eight hundred ninety-nine of these patients underwent gender-affirmation surgery with insight into the sex assigned at birth based on the presence of male or female sex organs, such as hysterectomy, oophorectomy, or complete penile amputation. Of 577 listed as “male,” 327 were assigned male at birth based on CPT codes, whereas 250 were assigned female at birth. Of 312 patients listed as “female,” 103 were assigned female at birth, whereas 209 were assigned male at birth. There is a lack of conformity concerning patient-identified gender and sex (Fig. 1).Fig. 1.: Transgender patient sex and gender designation in the National Surgical Quality Improvement Program database. NSQIP, National Surgical Quality Improvement Program; ICD, International Classification of Diseases.Some patients could not be accurately classified into sex at birth unless their procedure directly involved primary or secondary sexual organs. Transgender/nonbinary individuals face tremendous disparities in their health fueled by pervasive structural, interpersonal, and individual-level stigmata that jeopardize access to primary care and gender-affirming services.2 Inaccuracies in data reporting within this community make extensive database analysis for the transgender community challenging. The limitations in national databases regarding sex and gender reporting challenge surgical procedure assessments in transgender/nonbinary patients. In a patient population already heavily marginalized in medical academia, the lack of sex/gender inclusivity in these national databases prevents researchers from providing objective evidence of surgical access and outcomes. It would be beneficial to update classification systems in widely-used databases among participating hospitals to standardize protocols that offer consistent sex and gender data reporting. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article." @default.
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• W4290930488 date "2022-08-12" @default.
• W4290930488 modified "2023-10-17" @default.
• W4290930488 title "Efficacy of Sex-Based Procedure Analysis in Widely Used Surgical Databases: Caution Is Advised" @default.
• W4290930488 doi "https://doi.org/10.1097/prs.0000000000009511" @default.
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