Abstract

As a part of gender-affirming care, many transgender women undergo vaginoplasty surgery, which is increasingly being performed in the United States. There are significant knowledge gaps about adverse events associated with vaginoplasty as the majority of published papers report single-center results.To describe severe and overall 30-day adverse events following gender-affirming vaginoplasty using a large multicenter database.This is a retrospective cohort study of transgender women who underwent vaginoplasty between 2011 and 2019 using the American College of Surgeons National Surgical Quality Improvement Program database. Cases were initially identified by diagnosis codes for gender identity disorders and procedure codes for male-to-female vaginoplasty. Adverse events at 30 days were identified, including unplanned re-operation or readmission, blood transfusion, wound dehiscence, surgical site infections, thromboembolic disease, sepsis, cerebrovascular or cardiac events, and urinary tract infection. Surgical procedures were further stratified by Clavien Dindo Grade, a standardized classification system for registering surgical complications. A score of 0 is given if there are no adverse events, while scores of 1 and 2 refer to deviations from the normal postoperative course, which may include additional pharmacologic treatment, bedside-managed wound complications, and blood transfusions. Clavien Dindo scores of 3-4 include: surgical intervention or life-threatening complication requiring ICU management. Clavien Dindo score of 5 is given for any complication resulting in death.488 cases were eligible for inclusion in this study. The mean age of the cohort was 37.5 and race distribution was: 71.1% White, 15.2% Black, 5.5% Asian/Pacific Islander, and 8.2% Other. Of the cohort, 18.6% were Hispanic. Surgeries were performed by plastic surgeons (87.9%), urologists (8.6%), gynecologists (1.8%), and other specialists (1.6%). Concurrent non-genital surgery was performed in 17% of cases. Median operative time for all cases was 271 (IQR 214-344) minutes. There were no reported deaths in the 30-day period (Clavien Dindo Grade 5) and 5.5% (n=27) of cases had a Clavien Dindo score of 3-4. On multivariate analysis, body mass index and higher ASA class were associated with higher odds of having a Clavien Dindo 3-4 complication (adjOR 2.9, CI 1.32-4.21, p=0.01 and adjOR 1.23, CI 0.56-2.57, p=0.05, respectively). Wound dehiscence, superficial surgical site infection, or deep surgical site infection occurred in 9% (n=46) of cases. The readmission rate was 4.3% (n=21). Several preoperative factors had higher odds of readmission: body mass index (aOR 9.81, CI 1.77-22.13, p=0.005), higher ASA class (aOR 3.23, CI 1.23-9.03, p=0.003), diabetes (aOR 5.39, CI 1.42-20.45, p=0.006), and hypertension (aOR 3.63, CI 1.26-10.47, p=0.01). The reoperation rate was 4.7% (n=23), with no significant patient factors associated with this complication. Of the reoperations, 68.2% of cases were due to wound problems, vaginal bleeding, or hematoma.In transgender women undergoing vaginoplasty for gender affirmation, severe postoperative complications are rare, occurring in 1 in 20 patients. The majority of patients experience minor or no complications following surgery.

View details for DOI 10.1016/j.ajog.2023.01.011

View details for PubMedID 36669553