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

There is no universally agreed upon body mass index (BMI) cutoff for performing gender-affirming vaginoplasty. This study aimed 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 data sets from 2005 through 2022. Adult patients with an International Classification of Diseases-9 or International Classification of Diseases-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 in 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, class 2 or 3 obesity diagnoses significantly increased the risk of 30-day readmissions (odds ratio [OR], 33.6 [ P = 0.008]; OR, 69.1 [ P = 0.001], respectively), 30-day reoperations (OR, 25.3 [ P = 0.011]; OR, 61.4 [ P = 0.001], respectively), and operating room takebacks (OR, 25.3 [ P = 0.011]; OR, 61.4 [ P = 0.001], respectively). The risk of wound dehiscence was significantly higher for patients with class 3 obesity (19.5 [ P = 0.004]), but not for those with class 2 obesity (OR, 3.3 [ P = 0.377]).

Patients with class 3 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.