Wide-Awake Hand Surgery Has Its Benefits: A Study of 1,011 Patients

Kelly N McKnight; Vanessa J S Smith; Lisa N MacFadden; Alex C M Chong; Robert E Van Demark Jr

doi:10.1016/j.jhsg.2022.05.008

Wide-Awake Hand Surgery Has Its Benefits: A Study of 1,011 Patients

J Hand Surg Glob Online. 2022 Jun 17;4(6):394-398. doi: 10.1016/j.jhsg.2022.05.008. eCollection 2022 Nov.

Authors

Kelly N McKnight^{1

2}, Vanessa J S Smith³, Lisa N MacFadden⁴, Alex C M Chong^{1

2

5}, Robert E Van Demark Jr³

Affiliations

¹ Department of Graduate Medical Education, Sanford Health, Fargo, ND.
² School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND.
³ Sanford Orthopedics & Sports Medicine, Sioux Falls, SD.
⁴ Sanford Sports Science Institute, Sioux Falls, SD.
⁵ Sanford Sports Science Institute, Fargo, ND.

Abstract

Purpose: Wide-awake local anesthesia with no tourniquet has dramatically changed hand surgery practice. Using lidocaine with epinephrine and no tourniquet has allowed many procedures to be moved from the main operating room to an in-office procedure room. Previous studies have shown that using local anesthesia is safe and cost effective, with high patient satisfaction. This study evaluated patient satisfaction and complications for the first 1,011 elective hand surgeries performed using wide-awake anesthesia in an in-office procedure room.

Methods: The first 1,011 patients who underwent elective hand surgery in an in-office procedure room were surveyed regarding their satisfaction. The patients were monitored for postoperative complications. Patient survey results and complications were logged in a database and analyzed.

Results: Single-digit trigger finger release was the most common procedure performed (n = 582), followed by mass excision (n = 158), multiple-digit trigger finger releases (n = 109), and carpal tunnel release (n = 41). There were 43 (4.3%) superficial skin infections, with the majority seen in single-digit trigger finger releases (n = 27). There were no deep wound infections. All infections were managed nonsurgically with oral antibiotics and local wound care. Ninety-nine percent of the patients rated the in-office procedure room experience as the same as or better than a dental visit, would recommend wide-awake anesthesia to a friend or family member, and would undergo the procedure again. Using "lean and green" hand packs saved our institution more than $65,000 and saved 18.4 tons of waste during this study period.

Conclusions: Surgical procedures performed with wide-awake local anesthesia with no tourniquet in an in-office procedure room can be performed safely with a low infection rate, are cost effective, and have high patient satisfaction.

Clinical relevance: Minor hand surgery done in an in-office procedure room is safe, is cost effective, and has high patient satisfaction.

Keywords: Infection rate; Patient satisfaction; WALANT.