J Hand Microsurg
DOI: 10.1055/s-0043-1768484
Original Article

Safety and Efficacy of In-Office Hand Procedures

Brandon W. Knopp
1   Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, Florida, United States
,
Ehsan Esmaeili
2   Boca Raton Regional Hospital, Boca Raton, Florida, United States
› Author Affiliations
Funding None.

Abstract

Background The primary concerns with operating on patients in the office setting are insufficient sterility and lack of appropriate resources in case of excessive bleeding or other surgical complications. This study serves to investigate these concerns and determine whether in-office hand surgeries are safe and clinically effective.

Methods A retrospective review of patients who underwent minor hand operations in the office setting between December 2020 and December 2021 was performed. The surgical procedures included in this analysis are needle aponeurotomy, trigger finger release, foreign body removal, mass removal, and reduction in a finger fracture with or without percutaneous pinning. All fractures, which primarily included metacarpal and phalangeal fractures, were subsequently splinted. Sterility and hemostatic support were achieved via the Wide-Awake Local Anesthesia No Tourniquet (WALANT) method. Major complications were defined as infection, major bleeding, and neurological deficits. Minor complications were defined as prolonged pain, prolonged inflammation, residual symptoms, and recurrence of symptoms within 1 month.

Results Five patients (3.8%) returned to the office for pain, inflammation, or stiffness of the affected finger, with two of the five returning with symptoms associated with osteoarthritis or pseudogout flare-ups. Five additional patients returned due to residual symptoms or recurrence of the primary complaint within 1 month of surgery. No patients experienced exogenous infection.

Conclusion The absence of major complications and high success rate for minor hand procedures shows the high degree of safety and efficacy that can be achieved via the in-office setting for select procedures. While proper patient selection is key, our result shows the in-office procedure room setting can offer the necessary elements of sterility and hemostatic support for several common hand surgeries.

Informed Consent

Informed consent was obtained from all individual participants included in the study.




Publication History

Article published online:
22 May 2023

© 2023. Society of Indian Hand Surgery & Microsurgeons. All rights reserved.

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  • References

  • 1 Rhee PC, Fischer MM, Rhee LS, McMillan H, Johnson AE. Cost savings and patient experiences of a clinic-based, wide-awake hand surgery program at a military medical center: a critical analysis of the first 100 procedures. J Hand Surg Am 2017; 42 (03) e139-e147
  • 2 Duquette S, Nosrati N, Cohen A, Munshi I, Tholpady S. Decreased wait times after institution of office-based hand surgery in a veterans administration setting. JAMA Surg 2015; 150 (02) 182-183
  • 3 Goyal KS, Jain S, Buterbaugh GA, Imbriglia JE. The safety of hand and upper-extremity surgical procedures at a freestanding ambulatory surgery center. J Bone Joint Surg Am 2016; 98 (08) 700-704
  • 4 Urman RD, Punwani N, Shapiro FE. Office-based surgical and medical procedures: educational gaps. Ochsner J 2012; 12 (04) 383-388
  • 5 Hendee WR. To err is human: building a safer health system. J Vasc Interv Radiol 2001; 12 (01) ). Doi: DOI: 10.1016/s1051-0443(01)70072-3.
  • 6 Vila Jr H, Soto R, Cantor AB, Mackey D. Comparative outcomes analysis of procedures performed in physician offices and ambulatory surgery centers. Arch Surg 2003; 138 (09) 991-995
  • 7 Fish MJ, Bamberger B. . Wide-Awake Local Anesthesia No Tourniquet (WALANT) Hand Surgery. StatPearls [Internet]., U.S. National Library of Medicine, 9 Oct. 2021, Accessed April 9, 2023 at: https://www.ncbi.nlm.nih.gov/books/NBK570646/
  • 8 Kazmers NH, Peacock K, Nickel KB, Stephens AR, Olsen M, Tyser AR. Comparison of complication risk following trigger digit release performed in the office versus the operating room: a population-based assessment. J Hand Surg Am 2021; 46 (10) 877-887 .e3
  • 9 Goldfarb CA, Bansal A, Brophy RH. Ambulatory surgical centers: a review of complications and adverse events. J Am Acad Orthop Surg 2017; 25 (01) 12-22
  • 10 Lipira AB, Sood RF, Tatman PD, Davis JI, Morrison SD, Ko JH. Complications within 30 days of hand surgery: an analysis of 10,646 patients. J Hand Surg Am 2015; 40 (09) 1852-59.e3
  • 11 Calfee R. . “Dupuytren's Contracture.” JBJS Clinical Summary, 7 Dec. 2018. Accessed April 9, 2023 at: https://www.jbjs.org/summary.php?id=190
  • 12 Van Demark Jr RE, Becker HA, Anderson MC, Smith VJS. Wide-awake anesthesia in the in-office procedure room: lessons learned. Hand (N Y) 2018; 13 (04) 481-485
  • 13 Menendez ME, Lu N, Unizony S, Choi HK, Ring D. Surgical site infection in hand surgery. Int Orthop 2015; 39 (11) 2191-2198
  • 14 Jagodzinski NA, Ibish S, Furniss D. Surgical site infection after hand surgery outside the operating theatre: a systematic review. J Hand Surg Eur Vol 2017; 42 (03) 289-294
  • 15 Cabrejo R, Thomson JG. Cost analysis of trigger finger treatment. Plast Reconstr Surg Glob Open 2018; 6: 58 DOI: 10.1097/01.gox.0000546793.05523.46.
  • 16 Zhou C, Selles RW, Slijper HP. et al. Comparative effectiveness of percutaneous needle aponeurotomy and limited fasciectomy for Dupuytren's contracture. Plast Reconstr Surg 2016; 138 (04) 837-846
  • 17 Turowski GA, Zdankiewicz PD, Thomson JG. The results of surgical treatment of trigger finger. J Hand Surg Am 1997; 22 (01) 145-149
  • 18 Liu W-C, Lu C-K, Lin Y-C, Huang P-J, Lin G-T, Fu Y-C. Outcomes of percutaneous trigger finger release with concurrent steroid injection. Kaohsiung J Med Sci 2016; 32 (12) 624-629
  • 19 Chen NC, Srinivasan RC, Shauver MJ, Chung KC. A systematic review of outcomes of fasciotomy, aponeurotomy, and collagenase treatments for Dupuytren's contracture. Hand (N Y) 2011; 6 (03) 250-255
  • 20 Pess GM, Pess RM, Pess RA. Results of needle aponeurotomy for Dupuytren contracture in over 1,000 fingers. J Hand Surg Am 2012; 37 (04) 651-656