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Clinical Characteristics and Outcomes

Clinical Characteristics and Outcomes

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Article
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Purpose There is a high demand for minor hand surgeries within the veteran population. The objective of this study was to compare clinical outcomes and resource use at a Veterans Affairs Medical Center (VAMC) of hand surgeries performed in minor procedure rooms (MPR) and operating rooms using local anesthesia with or without monitored anesthesia ca...

Contexts in source publication

Context 1
... used the ASA score as a surrogate for medical comorbidities; it was similar between the MPR and operating room groups (2.46 MPR vs 2.31 operating room; P ¼ .055) ( Table 2). Among patients in the MPR group, 25 had diabetes (20.3%), 26 were obese (21.1%), and 11 had hypothyroidism (8.9%). ...
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... ¼ .191) ( Table 2). Postoperative infection was extremely low and similar between groups, with no infections in the MPR group and only 5 cases in the operating room group. ...
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... time between surgical consult and surgery was 6 days less for patients in the MPR group (15 days [IQR, 14 days] vs 21 days [IQR, 18 days]; P ¼ .004) ( Table 2). The MPR patients also required fewer personnel during surgery, averaging 4.76 people (SD, 0.77 people) compared with 4.99 people (SD, 0.81 people; P ¼ .015). ...
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... ¼ .001) ( Table 2). ...

Citations

Article
The minor procedure room (MPR) offers numerous advantages over the traditional operating room for performing many common hand surgeries. MPRs require less space, are subject to more practical architectural design standards, and facilitate more judicious use of disposable materials and unnecessary instruments than common hand surgeries. MPRs reduce costs to the system and patient at every step of the surgical workflow and improve efficiency by removing preoperative and postoperative monitoring requirements. Hand surgeons sometimes face resistance when attempting surgery in MPRs, often because of confusion about their design characteristics and capabilities. This article aims to clarify many of the major requirements for establishing an MPR and provide a guide to hand surgeons for performing safe, efficient surgery outside the operating room.
Article
Full-text available
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.