Should WALANT surgery be included in the training curriculum?

Thakkar, Mehul; Bednarz, Bartlomiej

doi:10.1016/j.bjps.2020.05.072

Cited by 5 publications

(4 citation statements)

References 2 publications

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“…67 WALANT facilitated "one-stop" clinics are likely to become the new normal 31 with educators calling for its incorporation into the plastic surgery training curriculum. 68 Rhee highlighted the invaluable utility of WALANT in conflict zones. Austere environments have limited access to anesthetic personnel or equipment.…”

Section: Resource Efficiencymentioning

confidence: 99%

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Wide Awake Local Anesthetic No Tourniquet in Hand and Wrist Surgery: Current Concepts, Indications, and Considerations

Sawhney,

Thacoor,

Nagra

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Background: Traditionally, the use of a pneumatic arterial tourniquet was requisite for safe and effective surgery of the hand. The use of arterial tourniquets necessitates the use of regional or general anaesthesia. Wide-awake local anaesthetic no tourniquet (WALANT) has emerged as a novel technique to overcome the limitations of tourniquet use in conjunction with regional/general anaesthesia. This review aimed to examine the safety and effectiveness of WALANT and provide guidance for surgeons with limited WALANT experience. Methods: A literature review of MEDLINE was performed up to March 2021 to identify all articles related to the use of WALANT in hand surgery. Any article reporting original data related to the use of WALANT was eligible for inclusion. Results: A total of 101 articles were identified through database searching. Of these, 79 met full inclusion criteria and described the use of WALANT in 19 elective and trauma procedures. Current data suggest that WALANT is safe and effective for use in a range of procedures. Conclusions: WALANT surgery is increasing in popularity as evidenced by the variety of surgical indications reported in the literature. There is limited comparative data on the cost-effectiveness of WALANT compared to conventional methods. Current data suggest that WALANT is safe, better tolerated by patients and associated with direct and indirect cost savings.

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Section: Resource Efficiencymentioning

confidence: 99%

“…67 WALANT facilitated “one-stop” clinics are likely to become the new normal 31 with educators calling for its incorporation into the plastic surgery training curriculum. 68 …”

Section: Nonoperative Benefits Of Walantmentioning

confidence: 99%

Wide Awake Local Anesthetic No Tourniquet in Hand and Wrist Surgery: Current Concepts, Indications, and Considerations

Sawhney,

Thacoor,

Nagra

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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“…The COVID-19 pandemic did move the needle forward in using WALANT for many procedures (86,87). It would be beneficial to include the WALANT technique in the surgical training curriculum, particularly for tendon repair and reconstruction in which the benefit of WALANT is likely to be higher (88). It will remain important that decision-making by the surgeons should be shared with the patient as the center and director of his own care.…”

Section: Future Prospectsmentioning

confidence: 99%

WALANT surgery of the hand: state of the art

Degreef,

Lalonde

2024

EFORT Open Reviews

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Wide-awake local anesthesia no tourniquet is named the WALANT technique. WALANT has had a major positive impact on cost, convenience, ecology, patient satisfaction, access to surgical care, and outcomes in hand surgery in the last 20 years. Safe and efficient application of the technique is based on two principles. The first principle is the tumescent injection of a large volume low concentration 0.25–1% lidocaine, with 1:100 000–1:400 000 epinephrine. The second principle of WALANT is that the proper injection should be almost painless, with the patient only feeling the first needle poke of a tiny 30G needle. This wide awake patient approach reduces pain, neuropraxia, and systemic side effects of sedation with preservation of motor control, thereby aiding balanced reconstruction in hand surgery.

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“…In another survey assessing use of the wide-awake, local anesthesia, no tourniquet approach among American Society for Surgery of the Hand members, only 62 percent of 869 members (response rate, 23 percent) responded that they incorporated it into their practice. 20 The survey noted lack of familiarity with the technique, operating room efficiency, and patient concerns to be the major barriers to adoption. Fortunately, in addition to adopting the wide-awake, local anesthesia, no tourniquet approach to aid in cost reduction, large surgeon groups may be able to negotiate higher professional fees with insurers due to no additional facility or anesthesia fees if performed in a nonfacility (i.e., office) setting.…”

Section: Ementioning

confidence: 99%

Are We Working Harder for Less Pay? A Survey of Medicare Reimbursement for Hand and Upper Extremity Surgery

Nayar

Wollstein

Sullivan

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Ongoing concern for declining Medicare payment to surgeons may incentivize surgeons to perform more cases to maintain productivity goals. The authors evaluated trends in physician payment, patient charges, and reimbursement ratios for the most common hand and upper extremity surgical procedures. Methods: The authors examined Medicare surgeon payment, patient charges, and surgical volume from 2012 to 2017 for 83 common surgical procedures, incorporating the year-to-year Consumer Price Index to adjust for inflation. The reimbursement ratio was calculated by dividing payment by charge. Weighted (by surgery type and volume) averages were calculated. Results: Total Medicare surgeon payment increased 5.6 percent to $272 million for the studied procedures. Patient charges were seven times greater than payment, growing 24 percent to $1.9 billion. Despite growth of total payment, the average overall weighted payment for a single surgery decreased 3.5 percent. The average weighted patient charge increased 8 percent, whereas the reimbursement ratio decreased 13 percent. A hand surgeon would need to perform three more cases per 100 in 2017 to maintain the same reimbursement received in 2012. After categorizing these 83 surgical procedures, distal radius fixation (>3 parts, 21 percent increase; >2-part intra-articular, extra-articular, and percutaneous pinning, 17 percent increase), bony trauma proximal to the distal radius (10 percent increase), and upper extremity flap (5 percent increase) were subject to the greatest increases in payment. Payment for forearm fasciotomy (39 percent decrease), endoscopic carpal tunnel release (30 percent decrease), and mass excisions proximal to the wrist (18 percent decrease) decreased the most. Conclusions: From 2012 to 2017, despite a disproportionate increase in procedure charges, Medicare surgeon payment has not decreased substantially; however, total reimbursement is multifactorial and involves multiple sources of revenue and cost.

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Should WALANT surgery be included in the training curriculum?

Cited by 5 publications

References 2 publications

Wide Awake Local Anesthetic No Tourniquet in Hand and Wrist Surgery: Current Concepts, Indications, and Considerations

Wide Awake Local Anesthetic No Tourniquet in Hand and Wrist Surgery: Current Concepts, Indications, and Considerations

WALANT surgery of the hand: state of the art

Are We Working Harder for Less Pay? A Survey of Medicare Reimbursement for Hand and Upper Extremity Surgery

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