Marsland, Samuel P.

Purpose: In this study, we compare the use of rescue antiemetics in transgender and gender-diverse (TGD) patients undergoing gender-affirming surgical procedures with cisgender patients undergoing matching procedures. Methods: TGD patients undergoing facial feminization, genitourinary, or chest procedures between 2018 and 2023 were matched to cisgender men and women controls (only women for chest/breast procedures) using age, smoking status, surgical duration, and year of surgery to compare the use of rescue antiemetics in the postanesthesia recovery room. Analyses were performed using generalized estimating equations with robust variance estimates to assess whether TGD patients’ risk for receiving rescue antiemetics differed from matched cisgender controls. Results: We identified 397 TGD patients assigned male at birth (AMAB) and 194 TGD patients assigned female at birth (AFAB) undergoing gender-affirming surgery. Regardless of gender identity, AFAB patients received more prophylactic antiemetics than AMAB patients. Both unadjusted and adjusted (for patient and procedural variables) analyses failed to find evidence that the need for rescue antiemetics differed between matched cisgender and TGD patients ( p > 0.41 for all unadjusted and p > 0.34 for all adjusted comparisons). Conclusion: When compared to matched cisgender controls, TGD patients undergoing gender-affirming procedures did not have a higher risk of needing postoperative rescue antiemetic therapy.

Background: The safety of triple antiemetic therapy consisting of ondansetron, haloperidol, and a steroid, to surgical patients is unknown. Objective: To determine the incidence of torsade de pointes (TdP) or death following perioperative administration of triple antiemetic therapy. Methods: A retrospective cohort study identified 19,874 patients who received 22,202 doses of triple antiemetics during the 2.5-year time frame from March 4, 2020 to September 7, 2022 for surgical nausea prophylaxis or treatment of nausea. These patients above were cross-matched with an electrocardiogram and adverse outcome database; this identified 226 patients with documentation of a QTc > 450 ms, all ventricular tachycardias including TdP within 48 hours of receiving triple antiemetic therapy, or death within 7 days of receiving ondansetron. Results: There were 3 patients who had documented VT (n = 3), but there were no documented incidents of TdP (n = 0). There were 9 codes called on patients within 48 hours of medication administration, and none of them were due to ventricular arrythmias (n = 0). A total of 11 patients died within 7 days of triple antiemetic therapy. Ten of the 11 deaths were determined to not be from the triple antiemetic. One patient died at home within 24 hours of the procedure of an unknown cause (n = 1). Conclusions and Relevance: No episodes of TdP were identified in patients receiving triple antiemetic therapy perioperatively, though the cause of death in 1 patient could not be determined. This suggest that low-dose triple antiemetic therapy is low risk for the development of TdP.