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Simple Logistic Regression Evaluating MPR Use by Procedure Type and Anesthesia Type

Simple Logistic Regression Evaluating MPR Use by Procedure Type and Anesthesia Type

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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
... ¼ .001) (Table 3). Carpal tunnel release, A1 pulley release, foreign body removal, and de Quervain's release were not predictive of MPR use. ...
Context 2
... use of MPRs for CTR, de Quervain's release, foreign body removal, and A1 pulley release was equivalent, all of which are typically done after trialing nonsurgical management. On the other hand, soft tissue mass excisions were about 74% less likely to occur in MPRs based on our study's results (Table 3). This is directly related to the VAMC's policy of performing soft tissue mass excision of a size greater than 5 cm in the operating room. ...

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.