# Comparative Analysis of 30-Day Complications in Transgender Men Undergoing Different Routes of Hysterectomy: A Study Utilizing American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Data

## TL;DR

This study compares the 30-day complication rates of different hysterectomy methods in transgender men using a national database.

## Contribution

The study is the first to analyze postoperative complications of various hysterectomy approaches specifically in transgender men.

## Key findings

- Laparoscopic hysterectomy (LH) had the lowest complication rates compared to other methods.
- LAVH was associated with a higher risk of unplanned intubation and bleeding requiring transfusion.
- Abdominal hysterectomy (AH) showed increased odds of bleeding requiring transfusion.

## Abstract

Introduction: Gender-affirming surgeries, including hysterectomy, have been shown to reduce distress and improve quality of life for transgender men. However, the safety and efficacy of different hysterectomy approaches in transgender men have not been extensively studied. Here, we aim to compare postoperative complications among the different hysterectomy approaches in transgender men.

Methods: This retrospective cohort study utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2012 to 2020 to compare 30-day postoperative complications across different routes of hysterectomy in transgender men. Transgender men who underwent hysterectomy were identified using International Classification of Diseases (ICD)-9 and ICD-10 codes for gender dysphoria. Routes of hysterectomy included laparoscopic hysterectomy (LH), laparoscopic-assisted vaginal hysterectomy (LAVH), abdominal hysterectomy (AH), and vaginal hysterectomy (VH). Descriptive statistics, bivariate analysis, and multivariate logistic regression were performed to evaluate the association between hysterectomy routes and complications.

Results: A total of 1333 transgender men were included. Most patients underwent LH (N=1068, 80.1%), followed by LAVH (N=169, 12.7%), VH (N=54, 4.1%), and AH (N=42, 3.2%). The overall 30-day incidence of complications was 6.5%, with surgical site infection and unplanned reoperation being the most common complications. LAVH was associated with a higher incidence of unplanned intubation, while AH had a higher incidence of bleeding requiring transfusion. After adjusting for baseline comorbidities, LAVH was associated with significantly greater odds of unplanned intubation compared with LH (adjusted odds ratio (aOR) 95% confidence interval (CI) 28.1 (2.3->100)).

Conclusion: This study provides important insights into the 30-day postoperative outcomes of different hysterectomy approaches in transgender men. LH appears to have the lowest incidence of complications, whereas LAVH and AH present higher risks for specific complications. These findings can aid in informed decision-making and surgical planning, ultimately improving care for transgender men undergoing hysterectomy.