The following is a summary of “Postoperative adverse events following gender-affirming vaginoplasty: an American College of Surgeons National Surgical Quality Improvement Program study,” published in the MAY 2023 issue of Obstetrics and Gynecology by Mishra, et al.

Vaginoplasty surgery is a common component of gender-affirming care for transgender women, with an increasing number of procedures being performed in the United States. However, there is a lack of comprehensive data on adverse events associated with vaginoplasty, as most published studies report results from single-center experiences. For a study, researchers sought to examine severe and overall 30-day adverse events following gender-affirming vaginoplasty using a large multicenter database, aiming to fill the knowledge gaps in this area.

The retrospective cohort study utilized the American College of Surgeons National Surgical Quality Improvement Program database. The study included transgender women who underwent vaginoplasty between 2011 and 2019. Adverse events occurring within 30 days of surgery were identified, including unplanned reoperation or readmission, blood transfusion, wound dehiscence, surgical site infections, thromboembolic disease, sepsis, cerebrovascular or cardiac events, and urinary tract infection. The severity of surgical complications was classified using the Clavien-Dindo grade system. According to the Clavien-Dindo classification system, a score of 0 indicates the absence of adverse events. Scores 1 and 2 indicate deviations from the normal postoperative course, which may involve additional pharmacologic treatment, management of wound complications at the bedside, or blood transfusions. Clavien-Dindo grades 3 to 4 encompass surgical interventions or life-threatening complications requiring intensive care unit management. A Clavien-Dindo grade 5 is assigned when a complication leads to the patient’s death.

The study cohort consisted of 488 eligible cases. The mean age of the cohort was 37.5 years, and the racial distribution was as follows: 71.1% White, 15.2% Black, 5.5% Asian or Pacific Islander, and 8.2% Other. Hispanic individuals accounted for 18.6% of the cohort. The majority of surgeries were performed by plastic surgeons (87.9%), followed by urologists (8.6%), gynecologists (1.8%), and other specialists (1.6%). Concurrent nongenital surgery was performed in 17% of cases. The median operative time for all cases was 271 minutes (interquartile range, 214–344). No deaths (Clavien-Dindo grade 5) were reported within the 30-day postoperative period. Severe complications (Clavien-Dindo grade 3 to 4) occurred in 27 cases (5.5%). 

In the multivariate analysis, an elevated body mass index and a higher American Society of Anesthesiologists class were linked to increased chances of experiencing a Clavien-Dindo grade of 3 to 4. The adjusted odds ratios were 2.9 (95% CI, 1.32 to 4.21; P = 0.01) for body mass index and 1.23 (95% CI, 0.56 to 2.57; P = 0.05) for the higher American Society of Anesthesiologists class. Wound dehiscence, superficial surgical site infection, or deep surgical site infection occurred in 46 cases (9.0%). The readmission rate was 4.3% (n=21). 

Several factors before surgery were associated with an increased likelihood of readmission. These factors include a higher body mass index (adjusted odds ratio of 9.81; 95% CI of 1.77 to 22.13; P = 0.005), a higher American Society of Anesthesiologists class (adjusted odds ratio of 3.23; 95% CI of 1.23 to 9.03; P = 0.003), diabetes mellitus (adjusted odds ratio of 5.39; 95% CI of 1.42 to 20.45; P = 0.006), and hypertension (adjusted odds ratio of 3.63; 95% CI of 1.26 to 10.47; P = 0.01).

The reoperation rate was 4.7% (n=23), with the majority of reoperations, 68.2% of cases attributed to wound problems, vaginal bleeding, or hematoma.

In transgender women undergoing vaginoplasty for gender affirmation, severe postoperative complications were rare, occurring in approximately 1 out of 20 patients. Most patients experienced minor complications or no complications after surgery. The findings from the multicenter study contributed to the understanding of adverse events associated with gender-affirming vaginoplasty and provided valuable insights for clinicians and patients.

Source: ajog.org/article/S0002-9378(23)00015-7/fulltext