D159. Predictors of Major and Minor Complications following Phalloplasty

Abstract

PURPOSE: Primary phalloplasty for gender affirmation has a high complication rate, with reported frequencies as high as 76.5%. There is currently no literature describing risk factors contributing to these complications. This is the first multi-institutional study conducted across the United States to determine the predictors of complications following first stage phalloplasty. METHODS: The National Surgical Quality Improvement Program database (2012-2020) was queried for transgender/non-binary patients and current procedural terminology (CPT) codes of flap or microsurgery procedures to select for first stage phalloplasty cases (regardless of flap). The primary outcome was incidence of major and minor complications; the secondary outcome was indication for reoperation. Bivariate analysis and multivariate logistic regression were performed to determine significant predictors of major and minor complications within one month following first stage phalloplasty. RESULTS: Of 139 patients who underwent phalloplasty, the most common complication was unplanned reoperation [n=21, 15%] due to hematoma evacuation [n=6, 31.6% of reoperations, 4.3% of all patients], followed by bleeding requiring transfusion [n=11, 7.9%] and unplanned readmission [n=8, 5.8%]. On multivariate regression, patients with longer operating times had significantly greater odds of major complications (unplanned reoperation, readmission, bleeding requiring transfusion, sepsis) [adjusted odds ratio (aOR) 95% confidence interval (CI) 1.009 (1.004-1.014)]. Patients who had smoked within a year of surgery had 20 times the odds of minor complications (surgical site infection, wound disruption, urinary tract infection, pneumonia) [aOR (CI) 20.44 (3.75->100)]. CONCLUSION: Reducing operating times, smoking cessation, and strict preoperative nicotine testing may assist in mitigating the odds of complications following phalloplasty.