Abstract
<h3>Study Objective</h3> To compare the risk of vaginal cuff dehiscence (VCD) following total hysterectomy among gender diverse (GD) persons and cisgender women (CW) and to identify factors associated with VCD. <h3>Design</h3> This is a retrospective cohort study among adults who underwent total hysterectomy for benign indications between 2014 and 2018 with at least 6-months of postoperative follow-up. <h3>Setting</h3> All surgeries were performed within an integrated closed healthcare delivery system. <h3>Patients or Participants</h3> Adult subjects who underwent non-emergent total hysterectomy for benign indications were included. Subjects who underwent subtotal hysterectomy, concomitant vaginectomy, and hysterectomy for obstetric or oncologic indications were excluded. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> The 18,151 cohort was comprised of 282 (1.6%) GD and 17,869 (98.4%) CW. Compared to the CW group, the GD group was significantly younger (30.8 vs 48.2 years, <i>P</i><0.01) and healthier (Charlson Comorbidity Index≥1 was 5.3% vs 10.4%, <i>P</i><0.01). Hysterectomies among GD had lower blood loss (61.4 vs 128.8 mL, <i>P</i><0.01) and lower rates of perioperative wound infection (0.4% vs 0.7%, <i>P</i><0.01). The overall rate of VCD was 3.9% in the GD group and 2.5% in the CW group (<i>P</i>=0.13). In bivariate analysis, identifying as GD was not a significant risk factor for VCD (OR 1.60, 95%CI 0.87-2.95), whereas hypertension (OR 1.43, 95%CI 1.17-1.74) and laparotomy relative to laparoscopy (OR 1.78, 95%CI 1.22-2.58) were significantly associated with VCD. <h3>Conclusion</h3> VCD is a rare postsurgical complication, and a 1.6-fold increased, non-significant risk among a younger, healthier group with less intraoperative blood loss and fewer post-surgical infections suggests that our findings may represent a clinically significant difference. Hypertension and route of hysterectomy were found to be associated with VCD. We plan to analyze the data using multivariable analyses to control for confounders. We also plan to examine relationship between VCD and gender-affirming use of systemic testosterone by GD persons as a potential explanation for this clinical discrepancy in VCD.
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