8944 Outcomes Among Patients Undergoing Gender-Affirming Hysterectomy from 2010-2020: A NSQIP Analysis

Abstract

<h3>Study Objective</h3> We utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database, to study reoperation rates after benign hysterectomy in transgender and gender nonconforming (TGNC) patients. <h3>Design</h3> Demographic data and surgical outcomes between 2010-2020 were abstracted from the ACS NSQIP database. <h3>Setting</h3> ACS NSQIP Database. <h3>Patients or Participants</h3> Current Procedural Terminology (CPT) codes were used to identify patients who underwent hysterectomy for non-oncologic indications. ICD-9/10 codes were used to identify patients with gender dysphoria. 445,997 hysterectomies were performed between 2010-2020, of which 2,011 (0.45%) were for TGNC patients. <h3>Interventions</h3> Associations between gender dysphoria and unplanned re-operation were examined using propensity score-adjusted logistic regression. Propensity scores were calculated using the variables of: Age, race, BMI, ethnicity, hypertension requiring medication, and diabetes. <h3>Measurements and Main Results</h3> The percent of hysterectomies for TGNC patients increased between 2010-2020 (21 (1.0%) to 379 (18.6%), p< 0.01). TGNC Patients were younger (mean age 35.6 vs. 49.5), less likely to use anti-hypertensive medications (12.7 % vs. 29.7%), and less likely to have diabetes (4.4% vs. 9.7%), compared to non-TGNC patients, p< 0.001. Body mass index was similar between groups (28.3 IQR [24.2, 33.4] vs. 29.9 IQR [25.5, 35.7]). The risk of reoperation in this cohort was low overall (6,600 (1.5%)), and similar between groups (6,568 (1.5%) vs. 32 (1.6%), p = 0.747). A propensity-score adjusted linear regression demonstrated no increased risk of reoperation for cisgender compared to gender diverse patients (aOR 1.01 95%CI [0.99-1.01]). <h3>Conclusion</h3> Benign hysterectomy carries a low overall risk of reoperation. There was no difference in reoperation among TGNC patients, even when controlling for differences in health status. Hysterectomy continues to be a safe, medically necessary procedure for TGNC patients.