SITE OF SERVICE

No high- or moderate-quality studies were identified to address the question related to the association of site of carpal tunnel release on outcomes. Five low-quality studies were identified, most of which were single-surgeon, single-institution and/or retrospective or database studies evaluating carpal tunnel release conducted in the office setting as compared to the operating room setting (Halvorson 2020, Miller 2022, Moscato 2021, Randall 2021, Stephens 2021). These studies consistently demonstrated that carpal tunnel release in the office setting results in no increased risk of complications with higher ratings of patient experience and satisfaction when compared to surgical release in the operating room.

When examining surgical site infection (SSI) rates, Halvorson et al. (2020) discerned no significant disparity between clinic-based procedure rooms (PR) and traditional operating rooms (OR). In terms of patient experience and satisfaction, Miller (2022) highlighted the advantages of office-based procedures utilizing wide awake local anesthesia (WALANT). Patients in the office reported heightened enjoyment, reduced anxiety, and an overall more positive experience compared to those in the OR. Exploring patient satisfaction in relation to anesthesia and surgical settings, Moscato's study (2021) illuminated the superiority of office-based CTR surgeries with WALANT over hospital-based procedures with regional anesthesia and sedation. This was underscored by consistent correlations between WALANT anesthesia and enhanced patient satisfaction across settings. Regarding medical complications, Randall (2021) revealed comparable safety profiles for office-based procedure rooms (PR) and OR settings. Notably, no substantial differences were found in major medical, surgical site, or iatrogenic complications between office and OR environments, underscoring the safety of CTR procedures regardless of the chosen setting.

Lastly, Stephens' study (2021) evaluated long-term outcomes after open CTR procedures. The transition from OR to PR in 2014 did not yield discernible discrepancies in patient demographics or postoperative outcomes measured using the Boston Carpal Tunnel Questionnaire (BCTQ), highlighting the enduring clinical effectiveness of CTR procedures across various procedural environments.

Benefits/Harms of Implementation
The benefits of surgical release in the office as compared to the operating room include potential time and cost savings for patients and hospital systems. There are also potential improvements in the patient experience with office based carpal tunnel release. Notably, patients eligible for office-based procedures should be appropriately chosen and willing to undergo surgical release awake with limited anesthesia.

Future Research
Future research should include randomized controlled trials of office vs OR based carpal tunnel release and cost effectiveness analyses of moving cases from the OR to the office.