Propensity-Adjusted Analysis Evaluating Early Discharge Within 2 Days After Gender-Affirming Vaginoplasty

INTRODUCTION: Although gender-affirming vaginoplasty (GAV) has become more common, optimal postoperative length of stay (LOS) remains unclear, with recommendations ranging from 3 to 9 days. As the transgender population grows, establishing standardized care is critical. Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, this study examines predictors of prolonged LOS in GAV and evaluates the safety of discharging patients within 2 days. METHODS: The ACS-NSQIP identified patients who underwent GAV from 2012 to 2022 and were grouped based on LOS: early (≤2 d) and prolonged (>2 d). Categorical variables were analyzed using the χ2 or Fisher exact tests, and continuous variables with Student t test or Wilcoxon rank-sum. Logistic regression with propensity adjustment was used for multivariate analysis. Significance threshold was set at P