Comparison of Surgical Complications in Staged Versus Combined Hysterectomy Approach in Masculinizing Bottom Surgery: A National Surgical Quality Improvement Program Analysis.

Abstract

Background: Masculinizing (female-to-male) gender-affirming bottom surgeries (GABS) commonly include hysterectomies and can be performed in a staged manner or at the time of masculinizing genital surgery. Prior studies with small patient cohorts have suggested that adopting a combined approach increases the likelihood of complications. This study aimed to characterize patients undergoing gender-affirming masculinizing genital surgery with and without concurrent hysterectomies and determine whether there were additive risks of concurrent procedures.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients with International Classification of Diseases-9/-10 gender dysphoria diagnoses who underwent masculinizing GABS (intersex for female to male, simple or complex scrotoplasty) from 2012 to 2022. Stratified by the presence of a concurrent hysterectomy, baseline characteristics, preoperative commodities, and 30-day postoperative outcomes were compared between single-stage GABS and those with concurrent hysterectomy.

Results: Of the 113 total patients included, 83 (73.5%) patients had a single-stage GABS and 30 (26.6%) patients had a GABS combined with hysterectomy. Baseline characteristics, including age, gender distribution, and preoperative comorbidities, were comparable between groups. The median operative time and hospital length of stay were similar between groups. However, single-stage GABS patients had higher rates of return to the operating room (14.5% vs 0.0%, P = .03), wound complications (22.9% vs 0.0%, P = .004), and all-cause complications (27.7% vs 6.7%, P = .02).

Conclusions: The results suggest that performing hysterectomies at the time of masculinizing GABS can be safe in appropriately selected patients. These findings highlight the potential safety benefits of combining GABS with hysterectomy and underscore the need for further research into optimizing outcomes for diverse patient populations, as a combined approach may improve efficiency, aid access to care, and improve patient satisfaction.