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Elevated Body Mass Index is Not Associated with Significant Surgical Risk in a Cohort of 632 Patients Undergoing Gender-Affirming Vaginoplasty
Peter Shamamian
*1, Anya Wang
1, Subha Karim
1, Derek Chen
1, Carol Wang
1, Keisha Montalmant
1, Olachi Oleru
1, Janet C. Coleman-Belin
1, John H. Pang
3, Avra Laarakker
2, Ann Tran
2, Bella Avanessian
2, Jess Ting
2, Elan Horesh
21Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, Tenafly, NJ; 2Mount Sinai Center for Transgender Medicine and Surgery, New York, NY; 3Align Surgical Associates, San Francisco, CA
Background: Body mass index (BMI) has been associated with increased complications after surgical procedures. Prior studies on gender-affirming vaginoplasty have evaluated the safety of the procedure in patients with elevated BMI. This study aims to demonstrate the safety of the procedure through a larger cohort of vaginoplasty patients.
Methods: A retrospective review of gender-affirming vaginoplasty patients between June 2019 to July 2023 was conducted. Patients were separated into four BMI categories: underweight and normal weight (<25.0 kg/m
2), overweight (25-29.9 kg/m
2), class I obesity (30-34.9 kg/m
2), and class II/III obesity (≥35 kg/m
2). Univariate and multivariate analyses were used to compare characteristics and outcomes between groups. Statistical significance was set at p<0.05.
Results: Six hundred thirty-two (632) patients were included in the study. In total, 323 patients (51.1%) were categorized as underweight or normal weight, 191 overweight (30.2%), 97 class I obese (15.3%), and 21 class II/III obese (3.3%). Age, self-identified race, spoken language, BMI, diabetes mellitus, hypertension, dyslipidemia, duration of hormonal therapy, operative time, and estimated blood loss were significantly different between the BMI categories (p<0.05). There was significantly higher minor graft loss in class I obese patients (p=0.042) and major hematomas in class II/III obese patients (p=0.013), but neither of these were associated with increased odds on multiple logistic regression (p>0.05). Overweight patients were at increased odds of readmission (OR 2.243, 95% CI 0.999-5.037, p=0.050). There was no significant difference or increased odds of other complications by BMI category (p>0.05).
Conclusion: Elevated BMI is not significantly associated with an increased odds of postoperative complications in patients undergoing gender-affirming vaginoplasty, and is likely not an intrinsic risk factor for operative complications. BMI should likely not be considered an absolute or relative contraindication for most patients undergoing these life-changing procedures.
Table 1. Multiple logistic regression analysis evaluating odds of complications within each BMI category. Underweight/Normal Weight (BMI <25 kg/m2) was used as the reference category. Covariates included age, race, diabetes mellitus, hypertension, dyslipidemia, smoking, alcohol use, hormonal therapy time, vaginoplasty type, and operative time.
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