title: Surgical site infections in genital reconstruction surgery for gender reassignment, Detroit: 1984-2008.
abstract: BACKGROUND
  Gender reassignment surgery (i.e., male-to-female or female-to-male) entails a series of complex surgical procedures. We conducted a study to explore epidemiologic characteristics of patients who underwent genital reconstruction operations as components of gender reassignment and to analyze risk factors for surgical-site infections (SSIs) following these operations.
  
  
  METHODS
  The study was a retrospective cohort study conducted from 1984-2008 at Harper University Hospital, a tertiary hospital with 625 beds in Detroit, Michigan. Surgical site infection was defined according to established criteria.
  
  
  RESULTS
  Records were available for 82 patients who underwent a total of 1,383 operations as part of genital-reconstruction processes. Thirty-nine (47.6%) of the patients underwent female-to-male reassignment (FTM) and 43 (52.4%) underwent male-to-female reassignment (MTF). The average age of the study cohort was 39.5±9.8 y. Of the patients in the cohort, 56 (68.3%) were Caucasian and 67 (81.7%) were single. The average number of operative encounters per patient was 11.8±4.6 for FTM and 4.9±2.4 for MTF. Forty-three (52.4%) patients developed an SSI at least once during their genital reconstruction process, of whom 34 (87%) were in the FTM group and nine (21%) in the MTF group (p<0.001). Staphylococci were the most common pathogens (61%) isolated in these infections, followed by Enterobacteriaceae (50%), Enterococcus (39%), and Pseudomonas aeruginosa (33.3%). Surgical site infection was associated independently with an increased frequency of operative procedures and operating room encounters.
  
  
  CONCLUSIONS
  More than 50% of patients who underwent genital reconstruction operations developed an SSI at some point during the genital reconstruction process. Surgical site infections are more common in FTM than in MTF reconstruction operations, and for both FTM and MTF, SSIs are associated independently with an increased frequency of total operative procedures and encounters.
authors.affiliation: 1 Department of Pharmacy Services, Detroit Medical Center, Wayne State University , Detroit, Michigan.
authors.forename: Jing J
authors.initials: JJ
authors.lastname: Zhao
authors.forename: Dror
authors.initials: D
authors.lastname: Marchaim
authors.forename: Mohan B
authors.initials: MB
authors.lastname: Palla
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Bogan
authors.forename: Kayoko
authors.initials: K
authors.lastname: Hayakawa
authors.forename: Ryan
authors.initials: R
authors.lastname: Tansek
authors.forename: Judy
authors.initials: J
authors.lastname: Moshos
authors.forename: Arunkumar
authors.initials: A
authors.lastname: Muthusamy
authors.forename: Harikrishna
authors.initials: H
authors.lastname: Kotra
authors.forename: Paul R
authors.initials: PR
authors.lastname: Lephart
authors.forename: Alan N
authors.initials: AN
authors.lastname: Wilson
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
mesh_terms: D000328:Adult; D001419:Bacteria / Q000302:isolation & purification; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D005835:Genitalia / Q000601:surgery; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data*; D012307:Risk Factors; D057830:Gender-Affirming Surgery / Q000009:adverse effects* / Q000706:statistics & numerical data*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology