Opioid Prescribing Patterns Associated with Selective Matrixectomies for Toenail Onychocryptosis: A TriNetX Analysis

Selective matrixectomy is a common intervention for painful onychocryptosis that is associated with mild-to-moderate postoperative pain. It can usually be managed effectively with non-opioid analgesics. We evaluated rates and factors associated with opioid prescribing following selective matrixectomy to guide physicians in counseling postoperative patients.

A retrospective cohort study was conducted using the TriNetX research network, querying for patients who underwent selective matrixectomy for onychocryptosis. Opioid prescriptions <3 days after selective matrixectomy were assessed, and Cox regression estimated hazard ratios and 95% confidence intervals for opioid prescribing, adjusting for factors associated with prolonged opioid use.

Among 97,208 patients who underwent selective matrixectomy, 14,759 received an opioid prescription <3 days postoperatively (15.2%), declining from 24.3% during 2008-2018 to 12.8% during 2018-2025. Female sex, older age, Asian race, antidepressant use, and histories of anxiety, depression, chronic pain, migraine, osteoarthritis, and back pain were associated with lower likelihood of opioid prescribing. Black/African American race, Hispanic/Latino ethnicity, prior benzodiazepine or opioid use, and fibromyalgia were associated with higher likelihood.

Opioid prescribing following selective matrixectomy was relatively common and may be more frequent than clinically necessary. Prescribing patterns appear influenced by demographic and clinical factors, suggesting an opportunity to refine postoperative pain management strategies.