Assessing Public Reported Perceptions of Low Risk Hand Surgery Provided in the Office vs an Ambulatory Surgery Center
Trevor Richard Tooley, MD1; Rachel S. Rohde, MD2; James E Feng, MD1; Jannat M Khan, MD1; Paul Scott Shapiro, MD3; Christina F Endress, MD1
1William Beaumont Hospital, Royal Oak, MI; 2Department of Orthopaedic Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, MI; 3Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, MI
Introduction: There is growing evidence for the efficacy and safety of wide-awake office-based low risk hand surgery. However, limited insight into how receptive patients may be of these procedures being performed outside of a traditional operating room. Here we evaluate the publicís perceptions and degree of tolerance of low-risk, office-based hand surgery.
Methods: A prospective survey study was performed utilizing a 33-question, paid, survey distributed via a clinically, validated, public, online marketplace. After collecting baseline demographics, participants were queried regarding their (pre-education) perceptions of undergoing low risk hand surgery in their surgeonís office and divided into 3 cohorts: In-Office Surgery (IOS), No In-Office Surgery (NIOS), or No Preference (NP). Educational material was then presented comparing three surgical settings and anesthetic types (Figure 1). Participants were asked which setting/anesthetic they would prefer for four described procedures: trigger finger release (TFR), digital cyst excision (CE), carpal tunnel release (CTR), and a distal radius fracture (DRF). Statistical analyses with unpaired t-tests and ?2 were performed. p<.05 was significant.
Results: In total, 509 respondents completed the survey with 266 (52%) in the IOS group, 104 (20%) in the NIOS group, and 139 (27%) in the NP group. Previous outpatient surgery was noted to be significantly most frequent in the IOS cohort (47.47%), followed by the NP (34.53%) and finally NIOS (30.77%; Table 1). Both IOS and NP cohorts were also more likely to believe surgical procedures could be performed in the ambulatory clinic setting (IOS: 89.85%, NP: 89.93%, NIOS: 48.08%). The remaining demographics and exposures to surgery were similar across the cohorts. After reviewing the education graphic (Figure 1), 50/139 NP group switched to agreement with in-office surgery. In terms of procedure-specific-questioning: 40.6% of individuals were amenable to in-office TRF and 58.3% for CE. Meanwhile, more invasive procedures (CTR 25.6%; DRF 9.8%) demonstrated less interest. The most influential factors determining surgical location were comfort during the procedure and total encounter time which was significant across groups (p<0.0001). Lastly, the IOS group overall favored the location of surgery be at the surgeonís discretion more so than the NIOS group (p<0.0001).
Conclusion: In-office, low risk, hand surgery appears desirable to a select group of the public. If presented with the option for an in-office trigger finger release or digital cyst removal, it is estimated approximately 40.6% and 58.3% would be amenable to in-office surgery. As in-office surgery grows it is important to consider public opinion.
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