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The Correlation of Surgical Setting with Narcotic Prescriptions Following Wide-Awake Carpal Tunnel Release: A Nationwide Analysis
Alexander J Kammien, BS1, Kevin G Hu, BA1, John Collar, MD1, K Lynn Zhao, MD1, Jonathan N Grauer, MD1 and David L Colen, MD2, (1)Yale School of Medicine, New Haven, CT, (2)Yale University School of Medicine, New Haven, CT

Prior studies have compared postoperative narcotic prescriptions between wide-awake and sedated carpal tunnel release (CTR), but none have investigated the association of narcotic prescriptions with surgical setting. The current study utilized a large, nationwide, administrative database to assess postoperative narcotic prescriptions following wide-awake CTR by surgical setting.
Patients with open CTR (CPT-64721) were identified in the 2010-2021 PearlDiver M157Ortho dataset. Exclusion criteria included age <18 years, <6 months of preoperative data, <1 month of follow-up, bilateral surgery, concomitant hand surgery and monitored anesthesia care or sedation.
Patients were stratified by surgical setting (operating room, office) and matched by age, sex, Elixhauser Comorbidity Index score and geographic region. Patients with opioid prescriptions within 6 months before surgery, opioid dependence or abuse, substance use disorder, back/neck pain, generalized anxiety disorder and major depressive disorder were identified.
The number of patients who filled narcotics prescriptions within 1 month after surgery and morphine milligram equivalent (MME) of prescriptions were analyzed with multiple logistic regression and multiple linear regression respectively.
Prior to matching, there were 286,452 surgeries in the operating room and 5,748 in the office. Each matched cohort included 5,713 patients.
In terms of opioid prescriptions filled, fewer patients with office-based surgery filled narcotics prescriptions (43% vs 58%, OR 0.55, 95% CI [0.51, 0.59], p<0.001). Patients with increased age or residence in the Northeast or West (relative to Midwest) had decreased odds of filling a prescription, while those with increasing comorbidity burden and prior opioid prescription had greater odds (Figure 1)
In terms of MME prescribed, office-based surgery predicted lower MME (β = -94, 95% [CI -169, -18], p < 0.001). Increased MME was associated with ECI score >5, residence in the West (relative to Midwest), prior opioid prescription, opioid dependence and chronic pain, while age >75 and depression were associated with reduced MME (Figure 2).
Office-based CTR is associated with decreased filled narcotics prescriptions and lower MME prescriptions, likely reflecting patient and provider attitudes about narcotic utilization and pain control. Further patient-level investigation of these findings may provide insights that can contribute to the continued reduction of narcotic utilization.

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