D61. Wide-awake Hand Surgery in the Office: Trends, Reimbursement, Opioids and Adverse Events

PURPOSE: 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, opioid prescriptions, and adverse events. METHODS: Patients with trigger finger release, carpal tunnel release, De Quervain's release, and mucous cyst excision were identified in PearlDiver (2010-2020). Exclusion criteria were concomitant hand surgery, sedation/monitored anesthesia, inpatient setting, follow-up <30 days, and age <18 years. Cohorts were stratified by surgical setting then matched by age, sex, Elixhauser Comorbidity Index score, and region. Primary endpoints included total and physician reimbursement and 30-day opioid prescriptions, emergency department visits, and surgical site infections. RESULTS: Between 2010 and 2020, the proportion of surgeries performed in the office increased. Office-based surgery demonstrated lower total and physician reimbursement. Following office-based surgery, patients filled fewer opioid prescriptions (p<0.001) with fewer emergency department visits and similar rates of surgical site infections. CONCLUSION: Office-based hand surgery is increasing in popularity. With reduced financial burden and opioid prescriptions and favorable rates of adverse events, office-based wide-awake hand surgery may provide better healthcare value for certain procedures, and more surgeries should be performed in the office when possible.