ACS NSQIP Matched Cohort Study of Gender-Affirming Versus Benign Hysterectomy

IMPORTANCE: As gender-affirming care expands, hysterectomies for gender dysphoria are increasing, but data comparing outcomes to benign hysterectomies remain limited. OBJECTIVES: The objectives of this study were to compare perioperative characteristics and 30-day outcomes between transgender and gender diverse individuals (TGDI) undergoing gender-affirming hysterectomy (GAH) and patients undergoing hysterectomy for benign indications, by surgical approach. STUDY DESIGN: This was a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program data (October 2015-December 2022). TGDI undergoing GAH were identified by gender dysphoria diagnosis and hysterectomy Current Procedural Terminology codes. Approaches included abdominal hysterectomy (AH), laparoscopic/robotic hysterectomy (L/RH), laparoscopically assisted vaginal hysterectomy (LAVH), and vaginal hysterectomy (VH). A matched cohort was created based on demographics and comorbidities. Primary outcomes were operative time, length of stay (LOS), and 30-day complications. RESULTS: A total of 975 TGDI undergoing GAH were included; 82% of GAHs were minimally invasive, mostly L/RH. GAH represented 0.7% of all benign hysterectomies, increasing over time (P