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Office Based Hand Surgery Using Walant: Results and Lessons Learned
Peter JL Jebson, MD
Spectrum Health, Grand Rapids, MI
Introduction: The purpose of this study was to review a single senior surgeons experience performing office based hand surgery using the WALANT technique. Given the rising expense of health care in the United States and the shifting of expenses to the patient in the form of high deductibles and co-pays a treatment strategy that incorporates WALANT, with satisfactory patient outcomes, a low complication rate, and significant savings to the patient and health care overall would be of benefit to the delivery of hand surgery in the future.
Methods: A surgical logbook with all office based hand surgery procedures was used to identify those patients who underwent a surgical procedure in an office procedural suite using the wide awake local anesthesia no tourniquet technique for anesthesia (WALANT) between January 1, 2015 and December 4, 2015. The records were reviewed to identify demographic information including patient gender, procedure type, outcome, complications, and patient satisfaction. In addition, financial modeling was used to determine the cost savings per case compared to performing the same surgery at an ambulatory surgery center.
Results: Surgery was performed in 320 consecutive patients (age, 16 to 91).There were 353 procedures performed including; 150 carpal tunnel releases, 39 trigger thumb releases, 95 trigger finger releases, 7 de Quervain’s releases, 37 hardware removals (5 wrist, 24 finger, and 8 thumb), 7 flexor tendon sheath ganglia excisions, 1 I and D finger, 4 hand laceration explorations, 4 mucous cyst excisions, 7 excisional biopsies, and 2 foreign body removals. There were no major complications. All but 2 patients stated that they would undergo the same technique again. The cost savings per case was approximately \ with a total savings of nearly \,000,000 for one surgeon in one year.
Discussion: Office based hand surgery using WALANT is safe and effective for various common hand conditions. The strategy is associated with significant cost savings to the patient and health care system. Patient satisfaction is high because they find the approach convenient and successful. The incidence of major complications is very low. The strategy can be used effectively when incorporated into a busy clinic schedule with attention to patient counselling and scheduling details. This approach can be used to negotiate improved reimbursement from third party payers.
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