Perioperative Patient Distress in Office-Based, Wide-Awake Hand Surgery
Shafic Sraj, MD1, Anthony Siler, Under Graduate1, John S. Taras, MD1, Joseph Prud'homme, MD2, Andrea B Lese, MD1, Wing Yan Cheung Jennings, BS1, Richard Gross, PhD1 and Stephanie Cox, PhD1, (1)West Virginia University, Morgantown, WV, (2)Department of Orthopaedics, West Virginia University, Morgantown, WV
Office-Based, Hand Surgery (OBHS) is gaining popularity compared to hand surgery done in the operating room because of its convenience and cost benefits. Some patients are concerned about being wide-awake during the surgery, however. Patient experience has not been previously assessed in OBHS, and exploring expected and actual distress levels allows patients to make informed decisions regarding OBHS. The goal of this study is to assess patient distress levels starting at the time of surgical decision through the early recovery phase. We recruited 57 patients to complete distress surveys prior to, during, and following OBHS in a prospective fashion. We collected the Amsterdam Preoperative Anxiety and Information Scale (APAIS) on two assessment times (AT) prior to surgery and Subjective Units of Distress/ Disturbance Scales (SUDS) on two AT prior and two AT following surgery. We assessed the sources of distress including undergoing surgery, awareness during surgery, needle stick, surgical pain, discomfort, and surgery outcome. The secondary goal was to identify patient variables that may contribute to patient distress.
APAIS did not change much between preoperative visit and immediately prior to surgery. All SUDS followed a pattern of increasing distress between the preoperative visit and immediately prior to surgery, then it dropped sharply immediately following surgery. The only distress that increased at 2 weeks postoperatively was that of the needle stick, but it did not reach the preoperative levels. We applied Analysis of Variance to APAIS and SUDS, and calculated the corresponding effect sizes. Age, Sex, Depression, Anxiety, History of Distress with General Anesthesia, and History of Prior Awake Surgery has a statistically significant effect on distress levels at various AT.
Conclusion: The level of distress experienced by patients undergoing office-based awake hand surgery was significantly less than their preoperative distress. The only distress that trended up at two weeks follow up was that of the needle sticks. Understanding patient experience will help surgeons gain knowledge about what causes patient distress in OBHS, develop screening tools for OBHS, and find methods to mitigate perioperative distress in OBHS.
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