118. The Relationship Between Surgical Complications and Gender Dysphoria Index After Primary Vaginoplasty: A Multiple Regression Analysis

PURPOSE: Surgical complications have been linked to worsened patient-reported outcomes. While primary and revisional vaginoplasty improve patient-reported gender dysphoria, the impact of surgical complications remains unexplored. Using the Gender Dysphoria Index (GDI), this study investigates the relationship between surgical complications and patient-reported gender dysphoria following primary vaginoplasty. METHODS: The Gender Dysphoria Index (GDI), a patient-reported measure of gender dysphoria on a 0-10 Likert scale (with 10 representing maximum gender dysphoria), was captured at a single center from 2016 to 2023 and is currently undergoing validation. Multiple linear regression was conducted with variables of interest as the independent variables and GDI as the linear dependent variable. Complications were coded as 0 (No) and 1 (Yes). Correlation between this one unit increase in complication and change in GDI was assessed via the unstandardized beta (B) with 95% Confidence Intervals (CI). Statistical significance was set at p<0.05. The statistical significance of each predictor value is reported as the t-value (t). Strength and direction of correlation is reported as standardized beta (β). Variables of interest included any surgical complication, stricture, stenosis, hematoma, edema, delayed wound healing, wound dehiscence, granulation tissue, vaginal prolapse, graft failure, fat necrosis, divergent urine stream, postoperative urinary tract infection, erythema or cellulitis, surgical site infection (SSI), hemorrhage or bleeding, return to the operating room, and revision surgery. RESULTS: This study included 338 primary vaginoplasty patients who reported GDI postoperatively. Average preoperative GDI was 7.08 (±2.71), with significant reduction to 1.89 (±1.98) in the postoperative period (p<0.001). Of the 161 patients with complications data, 93 patients reported any complication (61.6%). Multiple linear regression revealed graft failure to significantly impact postoperative GDI (t=2.12, p=0.037). The model predicts that presence of graft failure following PV increases postoperative GDI by 2.14 units (unstandardized B=2.14, CI=0.13 to 4.15). The standardized β coefficient implies a minimally-positive correlation (standardized β=0.22). The model also predicts that presence of edema following PV significantly increases postoperative GDI by 0.80 units (unstandardized B=0.80, CI=0.23 to 1.37, p=0.007, standardized β=0.37, t=2.78). The model for post-PV SSI may be considered borderline statistically significant and suggests an emerging trend toward elevating postoperative GDI (unstandardized B=4.58, standardized β=0.24, t=1.86, p=0.067). CONCLUSIONS: Of all complications examined, the current study suggests that graft failure and edema may meaningfully worsen GDI following primary vaginoplasty. Further investigation with a larger sample size is needed to validate these findings and identify any additional complications that may increase postoperative gender dysphoria.