{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:03:41Z","timestamp":1784264621532,"version":"3.55.0"},"reference-count":32,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T00:00:00Z","timestamp":1783728000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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\u2019s release, and mucous cyst excision from 2010 to 2022 were identified in PearlDiver\u2019s M170Ortho dataset. Exclusion criteria were concomitant hand surgery, inpatient setting, &lt;30 days of follow-up, age &lt; 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\u2019s +104%, mucous cyst +22%). Office-based surgery demonstrated lower total costs for all surgical cohorts and insurance types: commercial (\u221234% to \u221243%), Medicaid (\u221237% to \u221248%), Medicare (\u221230% to \u221237%). Office-based surgery had lower physician reimbursement for all surgical cohorts with commercial insurance (\u22123% to \u22129%) and Medicare (\u22125% to \u221213%). 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.<\/jats:p>","DOI":"10.3390\/jcm15145446","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T08:53:58Z","timestamp":1783932838000},"page":"5446","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Current Trends of Wide-Awake Hand Surgery in the United States"],"prefix":"10.3390","volume":"15","author":[{"given":"Alexander J.","family":"Kammien","sequence":"first","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Salib","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan","family":"Prsic","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2626-7278","authenticated-orcid":false,"given":"Jonathan N.","family":"Grauer","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4760-5002","authenticated-orcid":false,"given":"David L.","family":"Colen","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,11]]},"reference":[{"key":"ref_1","first-page":"249","article-title":"Wide-awake Hand and Wrist Surgery: A New Horizon in Outpatient Surgery","volume":"64","author":"Lalonde","year":"2015","journal-title":"Instr. Course Lect."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"443","DOI":"10.5435\/JAAOS-21-08-443","article-title":"Epinephrine in local anesthesia in finger and hand surgery: The case for wide-awake anesthesia","volume":"21","author":"Lalonde","year":"2013","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1177\/1753193417728427","article-title":"Conceptual origins, current practice, and views of wide awake hand surgery","volume":"42","author":"Lalonde","year":"2017","journal-title":"J. Hand Surg. (Eur. Vol.)"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e139","DOI":"10.1016\/j.jhsa.2016.11.019","article-title":"Cost Savings and Patient Experiences of a Clinic-Based, Wide-Awake Hand Surgery Program at a Military Medical Center","volume":"42","author":"Rhee","year":"2017","journal-title":"J. Hand Surg. Am."},{"key":"ref_5","first-page":"23","article-title":"Transition to total one-stop wide-awake hand surgery service-audit: A retrospective review","volume":"3","author":"Bismil","year":"2012","journal-title":"JRSM Short Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"312","DOI":"10.5999\/aps.2014.41.4.312","article-title":"Tumescent local anesthesia for hand surgery: Improved results, cost effectiveness, and wide-awake patient satisfaction","volume":"41","author":"Lalonde","year":"2014","journal-title":"Arch. Plast. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1177\/1558944716669693","article-title":"An Economic Analysis of MAC Versus WALANT: A Trigger Finger Release Surgery Case Study","volume":"12","author":"Codding","year":"2017","journal-title":"Hand"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.jhsa.2022.11.010","article-title":"Optimizing the Use of Operating Rooms by Transitioning Common Hand Surgeries Into the Office Setting","volume":"48","author":"Starr","year":"2023","journal-title":"J. Hand Surg. Am."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e2015951","DOI":"10.1001\/jamanetworkopen.2020.15951","article-title":"Comparison of Safety and Insurance Payments for Minor Hand Procedures Across Operative Settings","volume":"3","author":"Billig","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1097\/SAP.0b013e3181db7784","article-title":"A cost, profit, and efficiency analysis of performing carpal tunnel surgery in the operating room versus the clinic setting in the United States","volume":"66","author":"Chatterjee","year":"2011","journal-title":"Ann. Plast. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1016\/j.jhsa.2018.03.051","article-title":"Cost Implications of Varying the Surgical Technique, Surgical Setting, and Anesthesia Type for Carpal Tunnel Release Surgery","volume":"43","author":"Kazmers","year":"2018","journal-title":"J. Hand Surg. Am."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1097\/PRS.0000000000010961","article-title":"Wide-awake carpal tunnel release in the United States: Trends in volume and reimbursement by operative setting","volume":"154","author":"Kammien","year":"2024","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1177\/15589447241247247","article-title":"The correlation of surgical setting with perioperative opioid prescriptions for wide-awake carpal tunnel release","volume":"20","author":"Kammien","year":"2025","journal-title":"Hand"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.5435\/JAAOS-D-24-00674","article-title":"Wide-awake partial fasciectomy for Dupuytren contracture: A nationwide analysis of adverse events and reimbursement","volume":"33","author":"Kammien","year":"2025","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1097\/PRS.0000000000011651","article-title":"A nationwide analysis of complications, reoperations, and cost of wide-awake flexor tendon repairs","volume":"155","author":"Kammien","year":"2025","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/00005650-199801000-00004","article-title":"Comorbidity measures for use with administrative data","volume":"36","author":"Elixhauser","year":"1998","journal-title":"Med. Care"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"104395","DOI":"10.1016\/j.amsu.2022.104395","article-title":"Elective surgeries during and after the COVID-19 pandemic","volume":"81","author":"Mehta","year":"2022","journal-title":"Ann. Med. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Morris, M.T., Rolf, E., Tarkunde, Y.R., Dy, C.J., and Wall, L.B. (2022). Patient Concerns About Wide-Awake Local Anesthesia No Tourniquet (WALANT) Hand Surgery. J. Hand Surg. Am., 47.","DOI":"10.1016\/j.jhsa.2021.08.026"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S195","DOI":"10.21037\/jss.2019.04.20","article-title":"Ambulatory surgery center ownership models","volume":"5","author":"Badlani","year":"2019","journal-title":"J. Spine Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s11552-007-9043-5","article-title":"A detailed cost and efficiency analysis of performing carpal tunnel surgery in the main operating room versus the ambulatory setting in Canada","volume":"2","author":"Leblanc","year":"2007","journal-title":"Hand"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1097\/SAP.0000000000002990","article-title":"Decreasing Medicare Utilization, Reimbursement, and Reimbursement-to-Charge Ratio of Reconstructive Plastic Surgery Procedures: 2010 to 2019","volume":"88","author":"Gong","year":"2022","journal-title":"Ann. Plast. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1177\/1558944721990807","article-title":"An Analysis of Procedural Medicare Reimbursement Rates in Hand Surgery: 2000 to 2019","volume":"17","author":"Thornburg","year":"2022","journal-title":"Hand"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1177\/1558944715627631","article-title":"Geographic and Age-Based Variations in Medicare Reimbursement Among ASSH Members","volume":"11","author":"Gaspar","year":"2016","journal-title":"Hand"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1177\/1558944720964966","article-title":"Variability in Medicaid Reimbursement in Hand Surgery May Lead to Inequality in Access to Patient Care","volume":"17","author":"Baker","year":"2022","journal-title":"Hand"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1177\/1558944717734370","article-title":"Regional Variations of Medicare Physician Payments for Hand Surgery Procedures in the United States","volume":"14","author":"Veltre","year":"2019","journal-title":"Hand"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1177\/1558944716677536","article-title":"Prospective Evaluation of Opioid Consumption Following Hand Surgery Performed Wide Awake Versus With Sedation","volume":"12","author":"Miller","year":"2017","journal-title":"Hand"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1177\/1558944716646765","article-title":"Prospective Evaluation of Opioid Consumption Following Carpal Tunnel Release Surgery","volume":"12","author":"Chapman","year":"2017","journal-title":"Hand"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s11552-012-9474-5","article-title":"The patient\u2019s perspective on carpal tunnel surgery related to the type of anesthesia: A prospective cohort study","volume":"8","author":"Davison","year":"2013","journal-title":"Hand"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"103134","DOI":"10.1016\/j.otsr.2021.103134","article-title":"The impact of WALANT anesthesia and office-based settings on patient satisfaction after carpal tunnel release","volume":"109","author":"Moscato","year":"2021","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_30","unstructured":"British Society for Surgery of the Hand, and NHS Getting It Right First Time Programme (2022). Hand Surgery: Guidelines for Operating Outside of Main Theatres, BSSH\/GIRFT."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1177\/15589447231158810","article-title":"Elective Ambulatory Unit: Experience of Local Anesthetic Only Surgery During the Pandemic","volume":"19","author":"Jeans","year":"2024","journal-title":"Hand"},{"key":"ref_32","unstructured":"American Academy of Orthopaedic Surgeons, and American Society for Surgery of the Hand (2024). Clinical Practice Guideline for the Management of Carpal Tunnel Syndrome, AAOS. 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