# Upper Extremity Surgical Outcomes in Transgender Trauma Patients

## TL;DR

This study found that transgender patients had similar surgical outcomes to cisgender patients after upper extremity surgery, despite higher rates of mental health conditions.

## Contribution

The study is the first to compare postoperative outcomes between transgender and cisgender patients undergoing upper extremity surgery.

## Key findings

- Transgender patients had higher rates of psychiatric diagnoses but no significant differences in complication rates.
- There were no significant differences in re-operation, infection, or hardware failure between the groups.
- Mean PHQ-9 scores were not significantly different between transgender and cisgender patients.

## Abstract

Introduction: Transgender individuals experience disproportionately high rates of mental health conditions. Previous studies have shown that psychosocial comorbidities impact recovery and outcomes after upper extremity surgery, where functional outcomes have been shown to be closely tied to pain perception and psychological well-being. Despite the increasing visibility and healthcare utilization of transgender patients, little is known about whether their postoperative outcomes differ from those of cisgender patients following upper extremity surgery. This study aimed to compare clinical and psychosocial outcomes after hand and upper extremity surgery between transgender and cisgender patients at a single tertiary-care academic institution.

Methods: A retrospective chart review of patients undergoing upper extremity surgery between 2015 and 2023 was performed. Transgender patients were identified using ICD-9/10 codes for gender dysphoria and were matched to cisgender controls.

Results: Fifty-three patients were included: 33 cisgender and 20 transgender patients. While psychiatric diagnoses were significantly more prevalent in the transgender group (71.4% vs. 35.3%, p=0.01; OR4.99, 95%CI:1.51-19.19), there were no statistically significant differences in complication rates (p=0.99), re-operation (0.19), infection (0.68), or hardware failure (0.47). Mean PHQ-9 scores were also not significantly different between groups (p=0.11).

Conclusion: Despite significantly higher psychiatric comorbidity, transgender patients undergoing upper extremity surgery demonstrated equivalent postoperative outcomes when compared to their cisgender peers. These findings suggest that transgender status alone should not be considered a risk factor for adverse outcomes in hand surgery. Ongoing work is necessary to better understand how gender identity, mental health, and access to gender-affirming care interact to shape surgical recovery.