(Poster 83) Comparing Perioperative Outcomes in Gender-Affirming and Cisgender Hysterectomy

Objectives: Gender-affirming hysterectomy (GAH) is a crucial procedure for transgender and gender diverse individuals seeking alignment with their gender identity. However, limited data are available comparing perioperative outcomes between transgender and cisgender patients undergoing this procedure. Understanding these differences is critical for optimizing surgical planning and improving patient care for transgender individuals. To compare perioperative outcomes of GAH to a matched cisgender cohort using data from the National Surgical Quality Improvement Program (NSQIP).

Methods: Transgender patients undergoing GAH between 2015 and 2022 were identified as patients in NSQIP who underwent hysterectomy with theICD-10 diagnosis code of gender dysphoria. Exclusion criteria included patients who underwent concomitant non-gynecologic surgeries, supracervical hysterectomy, and hysterectomy for cancer, and cases with missing data for uterine weight . A matched cohort analysis was performed based on age, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, smoking status, uterine weight, relevant comorbidities, and approach. To ensure adequate sample size and comparison robustness, the matched analysis was limited to laparoscopic/robotic total hysterectomy (LRTH) cases due to the limited number of other hysterectomy routes in the cohort. Operative time, hospital length of stay, and complication rates were compared between patients undergoing GAH and the matched control cohort.

Results: A total of 976 patients undergoing GAH (81.7% LRTH, 2.4% abdominal, 11.9% laparoscopic assisted vaginal, 4.1% vaginal). Over the study period, we observed a trend toward an increasing proportion of hysterectomies captured in NSQIP that were performed for gender affirmation indications (P < .001). 796/797 LRTH patients were matched to a control who underwent hysterectomy for an indication other than gender affirmation. Within the matched GAH cohort, 48.5% identified as male, 46.9% as female, and 4.6% as non-binary. Transgender patients had a significantly shorter operative time (median 97 minutes vs. 113 minutes, P < 0.001), but a longer hospital stay (median of 1 day vs. 0 days, P < 0.001). Complication rates were low in the overall cohort (1.4% with major complication, 3.0% with minor complication). No significant differences were noted between the two groups in terms of major or minor complication rates, rates of superficial or deep incisional surgical site infections, blood transfusion rates, or occurrences of deep vein thrombosis (DVT) or sepsis.

Conclusions: Transgender patients undergoing hysterectomy experience comparable complication rates to their cisgender counterparts. Although transgender patients had a shorter operative time, this did not correspond to a shorter hospital stay or faster discharge. These findings suggest that recovery for transgender patients may be influenced by factors beyond the surgical procedure itself, such as the need for a more individualized discharge plan tailored to the unique needs of transgender patients. Addressing these needs is essential for improving patient outcomes and ensuring equitable care for this population.