Comparison of Complication Risk Following Trigger Digit Release Performed in the Office Versus the Operating Room: A Population-Based Assessment

Safety and Efficacy of In-Office Hand Procedures

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.

Safety of immediate open traumatic extensor tendon repair performed at an emergency department minor procedure room

INTRODUCTION

The superficial location of the extensor tendons makes them particularly vulnerable to lacerations. Patients most commonly present to the emergency department (ED) after these injuries. We aimed to measure the safety of immediate surgical repair of traumatic open extensor tendon injuries in an ED minor procedure room (MPR) under local anesthesia, and the associated post-operative infection and complication rates.

MATERIALS AND METHODS

We retrospectively evaluated all patients undergoing traumatic open extensor tendon repairs in the ED MPR over a 3.75-years period. Data collected included demographic information, comorbidities, mechanism of injury, additional procedures performed, and post-operative complications. All patients were operated under local anesthesia by a hand surgery fellow aided by an ED technician.

RESULTS

Two hundred and forty eight patients (278 tendons) were treated for extensor tendon injuries during the study period. 220 patients (245 tendons) have complied with follow-up. No intra-procedural medical complications were encountered. The post-operative infection rate was 1.4%. The rate of other post-operative complications was not related to the number of tendons repaired, additional digit involvement, or if the nature of the injury was work-related.

CONCLUSIONS

In this cohort, traumatic extensor tendon repairs performed in an ED MPR were found to be medically safe and to associate with a low postoperative infection rate. As preoperative assessment is simple and practical, and limited medical personnel is utilized, this surgical setting may enable us to reduce medical costs.

Moving Minor Hand Surgeries Out of the Operating Room and Into the Office-Based Procedure Room: A Population-Based Trend Analysis

PURPOSE

Our primary purpose was to quantify the proportion of minor hand surgeries performed in the procedure room (PR) setting in a population-based cohort. Given the increase in the literature that has emerged since the mid-2000s highlighting the benefits of the PR setting, we hypothesized that a trend analysis would reveal increased utilization over time.

METHODS

We used the 2006-2017 MarketScan Commercial Database to identify adults who underwent isolated minor hand surgeries performed in PR and operation room surgical settings in the United States. The Cochran-Armitage trends test was used to determine whether the proportion of all procedures (PR + operation room) changed over time.

RESULTS

A total of 257,581 surgeries were included in the analysis, of which 24,966 (11.5%) were performed in the PR. There was an increase in the overall number of surgeries under study as well as increased utilization of the PR setting for open carpal tunnel release, trigger digit release, DeQuervain release, hand or finger mass excision, and hand or finger cyst excision. The magnitude of the increases in PR utilization was small: between 2006 and 2017, the PR utilization increased by 1.4% for open carpal tunnel release, 5.4% for trigger digit release, 2.9% for DeQuervain release, 10.1% for hand or finger mass excision, and 6.5% for hand or finger cyst excision.

CONCLUSIONS

Despite the published benefits of the PR setting, we observed that the majority of these 5 common minor hand surgeries are performed in the operation room setting. Between 2006 and 2017, the office-based PR utilization increased slightly. The identification of barriers to PR utilization is needed to improve the value of care.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic II.