From the Division of Plastic and Reconstructive Surgery, Department of Surgery.
Departments of Surgery.
Ann Plast Surg. 2024 Nov 1;93(5):e45-e49. doi: 10.1097/SAP.0000000000004030. Epub 2024 Jul 10.
Wide-awake and office-based hand surgeries are increasingly common. The association of these techniques with postoperative pain and pain control has garnered recent attention. A prior study demonstrated that office-based trigger finger release (TFR) were associated with decreased perioperative opioid prescriptions compared to those performed in the operating room. The current study provides an in-depth analysis of the association between surgical setting and perioperative opioid prescriptions for wide-awake TFR.
Patients undergoing TFR between 2010 and 2021 were identified in PearlDiver, a national administrative claims database. Exclusion criteria were age <18 years, <6 months of preoperative data, <1 month of postoperative data, bilateral TFR, and concomitant hand surgery. To identify wide-awake cases, patients with procedural codes for general anesthesia, monitored anesthesia care, sedation and regional blocks were excluded. Patients were stratified by surgical setting (office or operating room), then matched based on age, sex, Elixhauser Comorbidity Index score, and geographic region. Patients with prior opioid prescriptions, opioid dependence, opioid abuse, substance use disorder, chronic back/neck pain, generalized anxiety, and major depression were identified. Perioperative opioid prescriptions (those filled within 7 days before or 30 days after surgery) were characterized.
There were 16,604 matched wide-awake TFR patients in each cohort. In the cohort of office-based patients, 4,993 (30%) filled a prescription for perioperative opioids, in contrast to 8,763 (53%) patients who underwent surgery in the operating room. This disparity was statistically significant in both univariate and multivariate analyses. Univariate analysis indicated that office-based surgeries were linked to lower morphine milligram equivalents (MME) in opioid prescriptions than those performed in operating rooms (median of 140 vs 150, respectively). However, multivariate analysis demonstrated that opioid prescriptions for office-based surgeries were actually associated with greater MME.
Patients undergoing office-based TFR were less likely to fill perioperative opioid prescriptions but were prescribed opioids with greater MME. In wide-awake TFR, it appears that a disparity may exist in patient and provider beliefs about postoperative pain control. Future patient- and provider-level investigations may produce insights into perceptions of postoperative pain and pain control, which may be useful for reducing opioid prescriptions across surgical settings.
清醒和基于办公室的手部手术越来越常见。这些技术与术后疼痛和疼痛控制的关联引起了最近的关注。先前的一项研究表明，与在手术室进行的手术相比，基于办公室的扳机指松解术（TFR）与术后阿片类药物处方减少有关。本研究深入分析了手术环境与清醒 TFR 围手术期阿片类药物处方之间的关联。
在国家行政索赔数据库 PearlDiver 中，确定了 2010 年至 2021 年间接受 TFR 的患者。排除标准为年龄<18 岁、术前数据<6 个月、术后数据<1 个月、双侧 TFR 和同时进行手部手术。为了识别清醒病例，排除了具有全身麻醉、监测麻醉护理、镇静和区域阻滞程序代码的患者。患者按手术部位（办公室或手术室）分层，然后根据年龄、性别、Elixhauser 合并症指数评分和地理位置进行匹配。确定了有先前阿片类药物处方、阿片类药物依赖、阿片类药物滥用、物质使用障碍、慢性背部/颈部疼痛、广泛性焦虑症和重度抑郁症的患者。描述了围手术期阿片类药物处方（手术前 7 天内或手术后 30 天内开具的处方）。
在每个队列中，有 16604 名匹配的清醒 TFR 患者。在基于办公室的患者队列中，4993 名（30%）患者填写了围手术期阿片类药物处方，而在手术室接受手术的患者为 8763 名（53%）。这一差异在单变量和多变量分析中均具有统计学意义。单变量分析表明，与在手术室进行的手术相比，办公室手术与阿片类药物处方中的吗啡毫克当量（MME）较低相关（中位数分别为 140 和 150）。然而，多变量分析表明，办公室手术的阿片类药物处方实际上与更大的 MME 相关。
接受办公室 TFR 的患者不太可能开具围手术期阿片类药物处方，但开具的阿片类药物 MME 更大。在清醒 TFR 中，患者和提供者对术后疼痛控制的信念似乎存在差异。未来的患者和提供者水平的研究可能会深入了解术后疼痛和疼痛控制的认知，这对于减少手术环境中的阿片类药物处方可能是有用的。
