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To describe perioperative adverse events related to vaginoplasty surgery for transgender women and to determine a threshold case number needed to reduce adverse events.
Materials and Methods
This was a retrospective study of all women who underwent vaginoplasty at a tertiary care center. Women were included if 6-month outcomes were available. Once patients were identified, perioperative data were collected. Comparisons of adverse events and perioperative outcomes were made between varying threshold case numbers to determine the case number needed to significantly reduce adverse events. Once this threshold was determined, outcomes were compared between cases performed before and after this threshold.
Between December 2015 and March 2019, 76 vaginoplasty cases were performed. Mean age and BMI were 41 (±17) and 27.3 (±5.1). Of the patients, 83.4% (71) underwent full depth vaginoplasty while remaining patients underwent a zero-depth procedure. Median surgical time was 210 (138-362) minutes. Median follow-up was 12.5 (6-50) months. The incidence of any intraoperative adverse event was 2.6% (95% CI 1.8, 4.1) while the incidence of any immediate (<30 days) and delayed (>30 days) postoperative event was 19% (95% CI 16.4, 22.2) and 25% (95% CI 22.4, 28.4). A threshold of 50 cases was determined to be necessary to reduce adverse events in a clinically and statistically significant way. Cases performed after the first 50 cases had lower surgical times: 240 (162-362) vs 187 (138-224) minutes, p < 0.0001 and a lower incidence of delayed postoperative events: 15.4% vs 36%, p = 0.007, with a lower incidence of urinary stream abnormalities, introital stenosis and need for revision surgery. The incidence of intraoperative and immediate adverse events was not different between groups.
The incidence of serious adverse events related to vaginoplasty surgery is low while minor events are common. A threshold of 50 vaginoplasty cases is necessary to reduce delayed events including the need for revision surgery.
DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Cecile Ferrando: UpToDate, author, royalties.