Current Trends of Wide-Awake Hand Surgery in the United States

Background/Objectives: This national database study compares wide-awake hand surgeries in the United States performed in the operating room and office in terms of volume, reimbursement, narcotics prescriptions, and adverse events. Methods: Patients who underwent trigger finger release, open carpal tunnel release, De Quervain's release, and mucous cyst excision from 2010 to 2022 were identified in PearlDiver's M170Ortho dataset. Exclusion criteria were concomitant hand surgery, inpatient setting, <30 days of follow-up, age < 18 years, general/monitored anesthesia, and nerve block. Cohorts were stratified by surgical setting then matched by age, sex, Elixhauser Comorbidity Index score, and region. Primary endpoints included total and physician reimbursement (stratified by payor: commercial, Medicaid, Medicare) and 90-day narcotic prescriptions, emergency department visits, and surgical site infections. Results: Between 2010 and 2022, all surgical cohorts demonstrated an increase in the annual proportion of surgeries performed in the office (trigger finger +36%, carpal tunnel +155%, De Quervain's +104%, mucous cyst +22%). Office-based surgery demonstrated lower total costs for all surgical cohorts and insurance types: commercial (-34% to -43%), Medicaid (-37% to -48%), Medicare (-30% to -37%). Office-based surgery had lower physician reimbursement for all surgical cohorts with commercial insurance (-3% to -9%) and Medicare (-5% to -13%). Physician reimbursement was not significantly different by surgical setting for Medicaid patients. Following office-based surgery, patients filled fewer narcotic prescriptions and had lower rates of emergency department visits, with similar rates of surgical site infection. Conclusions: Although most wide-awake hand surgeries are still performed in the operating room, there is a nationwide increase in office-based surgery. With reduced financial burden and favorable rates of adverse events, office-based wide-awake hand surgery may offer improved economic value and comparable short-term safety for certain procedures. Future research should complement these findings with patient-reported outcomes.