Cost and Complications of Percutaneous Fixation of Hand Fractures in a Procedure Room Versus the Operating Room

Garon, Mark Tyson; Massey, Patrick A.; Chen, Andreas; Carroll, Trevor; Nelson, Bradley G.; Hollister, Anne M.

doi:10.1177/1558944717715105

Cited by 26 publications

(24 citation statements)

References 19 publications

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“… 18 When CTR cases were analyzed, they demonstrated even lower infection rates in the office, with an incidence of only 0.56%. This agrees with the multiple other studies that have shown no increase in infection rates when compared with the traditional OR 9 , 19 despite the OPR population being older with more comorbidities.…”

Section: Discussionsupporting

confidence: 92%

Infection Rate Comparison during Transition from Hospital to Office WALANT Enabled by Virtual Reality

Oakes

Wong

Schank

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: We transitioned our hand practice from the operating room (OR) to our office-based procedure room (OPR) to offer wide-awake, local anesthesia, no tourniquet (WALANT). We have established that using wide-awake virtual reality improves patient comfort and anxiety during wide-awake procedures and helps facilitate our patients' choice of venue. We aimed to assess the effect of this transition on infection rates for procedures performed by a single surgeon in the OR versus the OPR. Methods: A retrospective chart review was performed on a single surgeon's adult patients who underwent elective and closed traumatic upper limb surgeries. A surgical site infection was defined as superficial or deep, based on clinical examination conducted by the surgeon, and was treated with antibiotics within a 4-week postoperative window. Results: From August 2017 to August 2019, 538 (216 OR and 322 OPR) consecutive cases met inclusion criteria. There were six (2.78%) superficial infections and zero deep space infections in the OR cohort compared with four (1.24%) superficial and zero deep space infections in the OPR cohort with no statistical significance. Two-thirds of cases were converted to WALANT and delivered in the office. Conclusions: This narrative study concurs with the current literature that WALANT in the office setting is as safe as the hospital OR-based procedures for selected elective cases. By transitioning suitable cases from the OR to the OPR, a surgeon's overall infection rate should not change.

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Section: Discussionsupporting

confidence: 92%

Infection Rate Comparison during Transition from Hospital to Office WALANT Enabled by Virtual Reality

Oakes

Wong

Schank

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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“…Certain hand procedures have shifted toward management in the outpatient clinic setting as opposed to the OR. Specifically with regard to hand fractures, fixation in a procedure room is associated with lower cost and charges to patients and no difference in rate of postoperative infection, malunion, or nonunion 8. In a retrospective review, open carpal tunnel release under local anesthesia in a procedure room setting minimized direct surgical costs compared to the operating room or other modes of anesthesia 26.…”

Section: Discussionmentioning

confidence: 99%

Site of service of irrigation and debridement of open finger and hand fractures: a retrospective review of trends and outcomes

Wadhwa

Zhuang

Shapiro

et al. 2022

Current Orthopaedic Practice

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Background:Irrigation and debridement (I&D) of open finger and hand fractures can be performed in the emergency department as opposed to the operating room (OR), though reports of postoperative infection rates vary greatly. The authors hypothesized that I&D of open finger and hand fractures in the OR would decrease over time. They also describe rates of postoperative infection, reoperation, readmission, and costs. Methods:A large nationwide administrative claims dataset was retrospectively reviewed to identify patients who underwent I&D after open finger and hand fractures from 2007 to 2016. The incidence of I&D procedures performed outside the OR was reported and trends over the study period were assessed. Results:The proportion of open finger and hand fractures that underwent I&D outside the OR did not change significantly over time. Rates of postoperative surgical site infection, readmission, and reoperation were higher in the OR cohort at 90 days after the index stay. The OR cohort had greater total costs and out-of-pocket costs for the index stay. At 90 days, the OR cohort had greater total cost, but out-of-pocket costs were similar. Conclusions:Site of service for treatment of open finger and hand fractures has not significantly changed from 2007 to 2016. Given that total costs are significantly greater among patients undergoing I&D in the OR, prospective trials are needed to assess the safety of treating open finger and hand fractures outside of the OR to optimize management of these injuries.

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“…There is ample evidence that field sterility for simple (nonpermanent implant) hand operations, including closed K-wire fixation, yields low, acceptable infection rates with minimal patient morbidity. [50][51][52][53][54][55][56][57][58] When antibiotics such as cephalosporins are required, they can be given orally with 90% of the bioavailability of the intravenous route. 59,60 Although an exhaustive list of procedures cannot cover all possibilities, Table 4 illustrates broadly some of…”

Section: Safety Of Field Sterility Versus Full Sterilitymentioning

confidence: 99%

Guidelines for Wide-Awake Local Anesthesia Surgery with No Tourniquet in the Office Setting Using Field Preparation Sterility

Schank¹,

Engwall²,

Kuhns³

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Wide-awake local anesthesia surgery with no tourniquet, or WALANT, has become popular in surgery, especially among hand surgeons. With the increasing number of surgeons performing office-based procedures, this article provides guidelines that may be used in the office setting to help transition more traditional hospital operating room-based procedures to the office setting. This article outlines the benefits of performing office-based wide-awake local anesthesia surgery with no tourniquet and provides a step-by-step guide to performing procedures that can be easily incorporated into any hand surgeon's practice successfully and safely.

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Cost and Complications of Percutaneous Fixation of Hand Fractures in a Procedure Room Versus the Operating Room

Cited by 26 publications

References 19 publications

Infection Rate Comparison during Transition from Hospital to Office WALANT Enabled by Virtual Reality

Infection Rate Comparison during Transition from Hospital to Office WALANT Enabled by Virtual Reality

Site of service of irrigation and debridement of open finger and hand fractures: a retrospective review of trends and outcomes

Guidelines for Wide-Awake Local Anesthesia Surgery with No Tourniquet in the Office Setting Using Field Preparation Sterility

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