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American Association for Hand Surgery

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The Impact of Intraoperative Nursing Care on Peri-Operative Complications During Wide Awake Local Anesthesia Hand Surgery
Asif M Ilyas, MD, Orthopaedics, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA

INTRODCTION: With no established guidelines for the number of operating room personnel required for wide awake local anesthesia cases, the number of nurses needed in the room during these cases is unclear. The aim of this study was to evaluate outcomes of wide awake local anesthesia cases at surgery centers that utilized different numbers of operating room nurses.
METHODS: We conducted a retrospective chart review of patients who underwent wide awake local anesthesia hand surgery at four surgical sites between the dates over a 30 month consecutive period. Two of the surgical centers utilized 3 operating room nurses, and the other two centers utilized 2 operating room nurses. Outcomes included intraoperative case abortion due to critical change in patient vitals, intraoperative medication delivery, intraoperative IV placement for medication delivery, intraoperative conversion to sedation, intraoperative medical complications, and postoperative transfer to the emergency department or a hospital.
RESULTS: A total of 1,771 wide awake local anesthesia surgical patients were identified at the four separate surgery centers, with 925 patients undergoing surgery at a facility that used 2 nurses in the operating room, and 846 patients had surgery at a facility that used 3 nurses. Patient demographics were similar between both groups. There were zero intraoperative or postoperative recovery complications in either group during the study period.
CONCLUSION: There was no difference in perioperative complications between the surgery centers that utilized 3 versus 2 intraoperative nurses during wide awake local anesthesia hand surgeries. This study supports that limiting the nursing personnel for wide awake local anesthesia hand surgeries could be an efficient way to cut procedural costs without compromising patient safety.


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