Body Mass Index and Complication Rates Among Patients Undergoing Gender-Affirming Surgeries: An Analysis of the National Surgical Quality Improvement Project Database.

PURPOSE

To determine the relationship between body mass index (BMI) and complication rates among patients undergoing gender-affirming surgeries (GAS).

METHODS

The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried from 2015 to 2021. Patients who underwent a GAS were identified using International Classification of Diseases Ninth (ICD-9) and Tenth (ICD-10) codes. Current Procedural Terminology (CPT) codes were organized within 6 GAS subgroups: masculinizing top, masculinizing bottom, feminizing top, feminizing bottom, head and neck, and voice procedures. BMI was classified as underweight, healthy weight, overweight, or obese classes I-III using the Center for Disease Control and Prevention ranges. Demographic data included sex, age, race, and ethnicity. Descriptive statistics were used to characterize the study sample, and hierarchical logistic regression was used to examine the association between GAS, BMI, and surgical complications.

RESULTS

Among the 6771 cases, the majority had a BMI categorized as healthy weight (33.5%) or overweight (30.5%). Smaller proportions had obesity class I (18.6%), class II (8.4%), or class III (6.2%); 1.9% were underweight. BMI was not a significant predictor of complications among those undergoing masculinizing and feminizing top surgeries or head and neck surgeries. Among participants undergoing masculinizing bottom surgery, those with class 1 obesity were 70% less likely to have surgical complications compared to those with a healthy weight. For those undergoing feminizing bottom surgeries, participants with class 1 obesity were 3.3 times more likely to have surgical complications compared to those with a healthy weight.

CONCLUSION

BMI is commonly used to determine GAS eligibility, yet its utility in predicting complications is uncertain. Healthcare providers should consider the patient's overall health status when assessing GAS eligibility rather than relying on BMI alone.