High Incidence of Postoperative Nausea and Vomiting in Transgender Women Undergoing Facial Feminization Procedures

BACKGROUND: Postoperative nausea and vomiting (PONV) is a significant concern due to its impact on patient comfort, recovery time, and extended hospital stay. Previous research links higher PONV rates in women during their periovulatory phase to estrogen. This study investigates the PONV risk in transgender women after facial feminization surgery. METHODS: Retrospective chart reviews of transgender women aged older than 18 undergoing facial feminization from 2014 to 2020 were undertaken. Data included demographics, hormone use history, comorbidities, and PONV history. PONV was classified as any nausea/vomiting episode before discharge. Anesthesia records were examined, and PACU notes were analyzed for PONV indicators. A cis-gender male and female cohort undergoing rhinoplasty served as controls. RESULTS: Of the 282 transgender women receiving facial feminization surgery, 104 experienced PONV, marking a 37% PONV rate. Compared with the 11% PONV rate among cis-gender rhinoplasty patients, this was notably higher. Hormone therapy discontinuation showed no influence on PONV incidence. CONCLUSIONS: Transgender women undergoing facial feminization surgery have a 38% PONV rate, surpassing the 11% rate in cis-gender rhinoplasty patients and the general 20%–30% rate for all procedures, including the 25% for oral and maxillofacial surgery. This suggests a heightened PONV risk for transgender women after facial feminization procedures.