(28) Differences in Vaginoplasty When Performed in Childhood Versus Adulthood: A National Surgical Quality Improvement Program Study

Background: Vaginoplasties are performed for a variety of congenital or acquired indications from childhood through adulthood. There are considerable gaps in understanding whether the conditions treated by vaginoplasty or the associated risk of complications differ between pediatric and adult patients. This study aimed to assess types of vaginoplasties, underlying diagnoses, and complication rates in children and adults using large multicenter databases.

Methods: This retrospective cohort study utilized data from the American College of Surgeons National Surgical Quality Improvement Program adult and pediatric databases from 2012 to 2021. Children (aged < 18 years) and adults (greater than or equal to 18 years) who underwent vaginoplasty for any reason were identified using Current Procedural Terminology (CPT) codes for vaginoplasties performed. Multivariable logistic regression analyzed differences in diagnoses, surgeon specialties, and 30-day complications. This study was exempt from Institutional Review Board approval.

Results: We identified 232 children (mean age 6.2 years) and 209 adults (mean age 36.7 years) who underwent vaginoplasty. Surgical specialty differed between children and adults. Pediatric urology performed the majority of vaginoplasties in children, whereas plastic surgery performed the majority in adults (75% vs 70%, p< 0.001). Gynecology performed a similar percentage of procedures in both groups. The type of vaginoplasty also varied. Children underwent vaginoplasties coded as both with and without grafts (57291, 57292, 57335), but adults only underwent vaginoplasties coded with grafts (57335). Surgical indication also significantly differed with 97% of childhood vaginoplasties being for urethrovaginal conditions and 85% of adult vaginoplasties being for gender dysphoria. Overall, 30-day complications were comparable and relatively low in both groups. Adults were more likely to have a documented wound dehiscence (0% vs 5%; p< 0.001). Wound dehiscence occurred in isolated urethrovaginal procedures and gender dysphoria cases, with 82% of all disruptions found in the latter group.

Conclusions: We identified differences in surgery type, surgeon specialty, and diagnoses when comparing vaginoplasties performed in children and adults. Although complications were low overall, wound dehiscence was more common in adults, likely due to complexity in gender affirming vulvovaginoplasties. More research is needed to understand these differences, to optimize surgical techniques, and improve patient care across all ages.