Body Mass Index as a Predictor of Surgical Outcomes in Gender-Affirming Vaginoplasty: A Nationwide Analysis.

Abstract

There is no universally agreed upon body mass index (BMI) cutoff for performing gender-affirming vaginoplasty. This study aims to identify the relationship between BMI and postoperative outcomes, if any, following vaginoplasty in adult transgender patients. A retrospective analysis was performed using the National Surgical Quality Improvement Program (NSQIP) datasets from 2005-2022. Adult patients with an ICD-9/10 code diagnosis of gender dysphoria who underwent gender-affirming vaginoplasty were included. Multivariable logistic regressions were performed to assess the impact of BMI on surgical outcomes. Among 11,574,114 patients in the database, 312 patients underwent gender-affirming vaginoplasty. Patients among the higher obesity classes demonstrated higher rates of 30-day readmissions (p<0.001), 30-day reoperations (p<0.001), operating room takebacks (p<0.001), and wound dehiscence (p<0.001). Upon multivariable regression analysis, Obesity Class II and Class III diagnoses significantly increased patients' risk of 30-day readmissions (OR 33.6, p=0.008; OR 69.1, p=0.001), 30-day reoperations (OR 25.3, p=0.011; OR 61.4, p=0.001), and operating room takebacks (OR 25.3, p=0.011; OR 61.4, p=0.001). The risk of wound dehiscence was significantly higher for Obesity Class III patients (19.5, p=0.004), but not for Obesity Class II (OR 3.3, p=0.377). Patients with class III obesity have higher rates of dehiscence, reoperation, and readmission. Surgeons should consider these findings when discussing risks and expectations with patients during the informed consent process.