Age-related Trends and 30-day Postoperative Complications in Variations in Sex Characteristic-related Procedures: A National Surgical Quality Improvement Program Study.

STUDY OBJECTIVE: The goal of this study was to describe the age ranges in which common genital, gonadal, and reproductive variations in sex characteristic (VSC)-related procedures are done and evaluate the variability in 30-day postoperative complications based on age range to address ongoing uncertainties about optimal surgery age for VSCs.

METHODS: This was a retrospective cohort study utilizing data from the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database from 2012 to 2021. Included cases had a postoperative diagnosis associated with a VSC condition. Descriptive analyses were used. Fisher's exact test was used to test differences in complication risk.

RESULTS: Our final analysis included 48,227 cases. Most cases were performed on individuals under the age of 3. When comparing the risk of any short-term, surgical complication by age category for each procedure, only three had significant age differences: ureter/bladder procedures had a higher risk of complications when performed in individuals under 11, and urethral/hypospadias surgeries and scrotoplasties had higher complication rates when performed in those 11 or older. In NSQIP-P, over 5 times as many vaginoplasties and clitoroplasties were performed under the age of 3 as over the age of 11. There were no differences across age groups for any assessed type of complication in either vaginoplasties or clitoroplasties.

CONCLUSION: There were few variations seen in NSQIP-P-assessed complications by age at the time of surgeries performed for VSCs, including in vaginoplasties and clitoroplasties. Many later surgeries do not appear to result in significantly worse intraoperative and 30-day postoperative outcomes.