The Association of Surgical Setting With Opioid Prescribing Patterns Following Wide-Awake Trigger Finger Release.

Area of Science:

• Hand Surgery
• Pain Management
• Public Health

Background:

• Wide-awake and office-based hand surgeries are increasingly prevalent.
• Postoperative pain and its management are critical considerations for these procedures.
• Previous research indicated fewer opioid prescriptions for office-based trigger finger release (TFR).

Purpose of the Study:

• To conduct an in-depth analysis of the association between surgical setting and perioperative opioid prescriptions for wide-awake TFR.
• To compare opioid prescription patterns in office-based versus operating room settings for TFR.

Main Methods:

• A national administrative claims database (PearlDiver) was used to identify patients undergoing TFR between 2010 and 2021.
• Exclusion criteria included age <18, insufficient pre/postoperative data, bilateral TFR, and concomitant hand surgery.
• Patients were matched by age, sex, comorbidity index, and region; wide-awake cases were identified by excluding specific anesthesia codes.

Main Results:

• 16,604 matched patients were analyzed in each cohort (office vs. operating room).
• 30% of office-based TFR patients filled perioperative opioid prescriptions compared to 53% in the operating room setting (p<0.001).
• While univariate analysis suggested lower MME for office-based TFR, multivariate analysis indicated higher MME in these cases.

Conclusions:

• Office-based TFR is associated with a lower likelihood of perioperative opioid prescription filling.
• However, opioid prescriptions for office-based TFR may involve greater MME.
• Disparities in patient and provider beliefs regarding postoperative pain control may influence these prescribing patterns.