104. Evaluating the Impact of BMI on Postoperative Outcomes after Gender Affirming Surgery Article Swipe

PURPOSE: There is increasing evidence that gender-affirming surgeries (GAS) provide significant health benefits to transgender and non-binary patients who desire them, and are a necessary aspect of care. However, limited access and strict pre-operative surgical criteria prevent patients from receiving treatment. BMI cut-offs are frequently utilized in pre-surgical candidacy selection, but there is limited evidence showing that increased BMI is associated with surgical complications after GAS. The purpose of this study was to evaluate the impact of BMI on surgical complications, readmission rates, and reoperation rates after GAS using a large national database. METHODS: The 2010-2020 National Surgical Quality Improvement Program (NSQIP) was queried for GAS ICD/CPT codes. Patients were grouped by surgery (top/chest, bottom/genital, facial) and split into established BMI classifications: Underweight (<18.5), Normal-Weight (18.5 - 24.99), Overweight (25 - 29.99), Obesity Class 1 (30 - 34.99), Obesity Class 2 (35 - 39.99), Obesity Class 3 (>40). Patient characteristics and 30-day complication rates were recorded, and a multivariate logistic regression was used to identify independent predictors of complications after top surgery. RESULTS: Our patient cohort included 1865 transmasculine patients and 1466 transfeminine patients who underwent top surgery. In total, 36 (1.9%) incidences of complications were seen in the transmasculine group and 29 (2.0%) were observed in the transfeminine group. The results of the regression showed BMI classes up to and including obesity class 1 were not independent predictors of readmission, reoperation, or complication instance for both transmasculine and transfeminine procedures. No BMI classes significantly affected readmission rates after transfeminine top surgery, or reoperation after transfeminine and transmasculine surgery. BMI class 2 and class 3 were significantly associated with any complication (class 2 OR = 4.256, p = 0.004; class 3 OR = 3.926, p = 0.016) and readmission (class 2 OR = 6.504, p = 0.012; class 3 OR = 5.509, p = 0.045) rates for transmasculine patients. Class 2 obesity was a significant predictor for any complication (OR = 4.729, p = 0.007) after transfeminine surgery. CONCLUSION: Our data indicates that current BMI restrictions for top surgery can be safely expanded to include class 1 obesity with no increase in complication rates. Additionally, given that BMI was shown to have no effect on readmission rates in the transfeminine cohort or reoperation rates in both cohorts, there is reason to reexamine and further modify or expand BMI requirements for these surgeries as the benefits to patients may outweigh the risk.