NESPS - Propensity-Adjusted Analysis Evaluating Early Discharge within 2 Days After Gender-Affirming Vaginoplasty: Insights from a Decade-Long National Surgical Quality Improvement Database

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Propensity-Adjusted Analysis Evaluating Early Discharge within 2 Days After Gender-Affirming Vaginoplasty: Insights from a Decade-Long National Surgical Quality Improvement Database
Tricia Mae R. Raquepo^*¹, Mohammed Yamin¹, Micaela J. Tobin¹, Samantha Won¹, Sophia Ahn¹, Bradley Colarusso¹, Anirudh Kulkarni¹, Samuel J. Lin¹, Marrisa A. Kent², Ryan P. Cauley¹
¹Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA; ²Urology, Beth Israel Deaconess Medical Center, Boston, MA

Background: Gender-affirming vaginoplasty (GAV) has become more common, yet optimal postoperative length of stay (LOS) remains unclear, with recommendations ranging from 3 to 9 days. As the transgender population grows, establishing standardized care is critical. Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, this study identifies predictors of prolonged LOS in GAV and evaluates the safety of discharging patients within 2 days. Methods: The ACS-NSQIP identified GAV patients from 2012 to 2022, grouped by LOS: early (≤2 days) and prolonged (>2 days). Categorical variables were analyzed with Chi-square or Fisher's exact tests and continuous variables with t-tests or Wilcoxon Rank-Sum. Multivariate analysis used logistic regression with propensity adjustment. Significance was set at p<0.05. Results: A total of 663 patients were included. Significant differences between groups were observed for age, race, surgical specialty, and ASA classification (p=0.03, 0.03, 0.001, and 0.02, respectively). Patients with prolonged LOS had higher preoperative hematocrit (p=0.01) and longer operative times (p<0.0001). Early discharge had fewer complications (p=0.03), readmissions (2 vs. 25), and reoperations (4 vs. 25), though the latter were not statistically significant. Univariate logistic regression identified preoperative hematocrit, operative time, and surgical specialty as predictors of prolonged LOS, but only operative time remained significant in multivariate analysis. Prolonged LOS was associated with a threefold increase in complications (OR 3.28, CI: 1.24-8.75, p=0.02). Conclusion: Discharge by 2 days was associated with fewer complications and trends toward lower readmissions and reoperation rates, supporting early discharge as a safe option in selected patients.

Univariate and multivariate logistic regression models of pre-operative patient variables on prolonged length of stay

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