Background: Gender dysphoria is a condition that often leads to significant patient morbidity and mortality. Although gender-affirming surgery (GAS) has been offered for more than half a century with clear significant short-term improvement in patient well-being, few studies have evaluated the long-term durability of these outcomes. Methods: Chart review identified 97 patients who were seen for gender dysphoria at a tertiary care center from 1970 to 1990 with comprehensive preoperative evaluations. These evaluations were used to generate a matched follow-up survey regarding their GAS, appearance, and mental/social health for standardized outcome measures. Of 97 patients, 15 agreed to participate in the phone interview and survey. Preoperative and postoperative body congruency score, mental health status, surgical outcomes, and patient satisfaction were compared. Results: Both transmasculine and transfeminine groups were more satisfied with their body postoperatively with significantly less dysphoria. Body congruency score for chest, body hair, and voice improved significantly in 40 years' postoperative settings, with average scores ranging from 84.2 to 96.2. Body congruency scores for genitals ranged from 67.5 to 79 with free flap phalloplasty showing highest scores. Long-term overall body congruency score was 89.6. Improved mental health outcomes persisted following surgery with significantly reduced suicidal ideation and reported resolution of any mental health comorbidity secondary to gender dysphoria. Conclusion: Gender-affirming surgery is a durable treatment that improves overall patient well-being. High patient satisfaction, improved dysphoria, and reduced mental health comorbidities persist decades after GAS without any reported patient regret.

Background: Extremity amputation is a common procedure performed to treat a variety of different problems and affects quality of life in a number of ways. In addition to acute postoperative pain, amputations have been shown to cause chronic pain that is often neuropathic in many amputees. This study sought to better characterize the role of opioids in postoperative pain control in lower extremity amputees. Methods: Patients who underwent lower extremity amputation between 2010 and 2018 were identified in a national insurance-claims database using ICD-9, ICD-10, and CPT codes. Patient demographics, comorbidities, perioperative opioid use, and prolonged postoperative opioid use were then determined for both groups. Descriptive statistics and logistic regression analysis were utilized to evaluate the association of patient-related risk factors and neuropathic pain conditions with perioperative and prolonged postoperative opioid use. Results: In total, 2247 opioid-naive lower extremity amputees were identified. An estimated 54.7% of patients utilized opioids in the perioperative period, and 44.6% were found to have prolonged opioid use. Younger age (ages 40–50 versus older), history of chronic pain, migraines, lower back pain, Charlson Comorbidity Index greater than 1, preoperative benzodiazepine, muscle relaxant, anticonvulsant, and antidepressant use were all significantly related to prolonged postoperative opioid use. Conclusions: Prolonged postoperative opioid use is a problem that affects nearly half of lower extremity amputees and seems to be significantly related to the preoperative use of benzodiazepines, muscle relaxants, anticonvulsants, and antidepressants. Further research into the diagnosis and treatment of postamputation neuropathic pain is needed to prevent reliance on opioids in this patient population.