Ives Graham C, Fein Lydia A, Finch Lindsey, Sluiter Emily C, Lane Megan, Kuzon William M, Salgado Christopher J
Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, Mich.
Department of Obstetrics and Gynecology, LGBTQ Center for Wellness, Gender, and Sexual Health, University of Miami, Miami, Fla.
Plast Reconstr Surg Glob Open. 2019 Mar 13;7(3):e2097. doi: 10.1097/GOX.0000000000002097. eCollection 2019 Mar.
Gender affirmation surgery (GAS) has a positive impact on the health of transgender patients; however, some centers employ body mass index (BMI) as a strict selection criterion for surgical candidacy. Several single-center studies have found no clear correlation between BMI and complication rates. We conducted a retrospective multicenter study at 2 university-based centers to test the null hypothesis: obesity is not a significant determinant of the risk of acute surgical complications in patients undergoing penile inversion vaginoplasty (PIV).
This is a retrospective chart review of all adult patients at the University of Michigan and the University of Miami undergoing gender-affirming PIV with minimum follow-up time of 3 months between 1999 and 2017. A logistic regression model of analysis is used to examine the predictive factors for surgical complications and delayed revision urethroplasty in our patient sample.
One hundred and one patients met inclusion criteria for this study. The mean BMI at the time of procedure was 26.9kg/m (range 17.8-48.2). Seventeen patients (16.8%) had major complications and 36 patients (35.6%) had minor complications. On logistic regression analysis, none of the recorded covariates were significant predictors of delayed revision urethroplasty or major, minor, or any complications.
We found that obese patients can safely undergo GAS and that BMI alone should not preclude appropriately selected patients from undergoing GAS. We acknowledge that selection based on overall health and other medical comorbidities is certainly warranted for gender-affirming PIV and all other surgical procedures.
性别肯定手术（GAS）对跨性别患者的健康有积极影响；然而，一些中心将体重指数（BMI）作为手术候选资格的严格筛选标准。几项单中心研究发现BMI与并发症发生率之间没有明确的相关性。我们在两个大学附属医院中心进行了一项回顾性多中心研究，以检验零假设：肥胖不是阴茎翻转阴道成形术（PIV）患者急性手术并发症风险的重要决定因素。
这是一项对密歇根大学和迈阿密大学所有接受性别肯定性PIV手术的成年患者的回顾性病历审查，这些患者在1999年至2017年期间接受了至少3个月的随访。使用逻辑回归分析模型来检查我们患者样本中手术并发症和延迟修复尿道成形术的预测因素。
101名患者符合本研究的纳入标准。手术时的平均BMI为26.9kg/m（范围17.8 - 48.2）。17名患者（16.8%）发生了严重并发症，36名患者（35.6%）发生了轻微并发症。经逻辑回归分析，记录的协变量均不是延迟修复尿道成形术或严重、轻微或任何并发症的显著预测因素。
我们发现肥胖患者可以安全地接受性别肯定手术，仅BMI不应排除合适的患者接受性别肯定手术。我们承认，对于性别肯定性PIV和所有其他手术程序，基于整体健康状况和其他医疗合并症进行选择当然是必要的。
