Patient Experience Evaluation and Cost Savings Analysis of Carpal Tunnel Syndrome Decompression Surgery Using the WALANT Technique
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Published:
Jun 17, 2024
Keywords:
Hand, carpal tunnel syndrome, local anesthesia, epinephrine
Main Article Content
Abstract
Introduction: Wide-awake local anesthesia no tourniquet (WALANT) is an anesthetic technique that was developed to improve patient access to treatment and optimize the use of available medical resources in hand surgery. The main purpose of this study was to evaluate patient experience and hospital cost savings during surgical treatment of carpal tunnel syndrome (CTS) with this technique at a South American public hospital.
Materials and Methods: Between 2016 and 2022, a descriptive prospective observational study was conducted on patients with a clinical diagnosis of CTS who had undergone surgical treatment. Patient satisfaction was assessed using a questionnaire that asked about pain during different periods of time, anxiety, and the procedure itself. The costs of the anesthetic technique were also analyzed.
Results: 92 patients were evaluated and the majority of them were satisfied with their WALANT experience; 94.5% said they would choose this procedure again, citing low levels of pain and anxiety. A cost reduction of 60.6% per procedure was achieved.
Conclusions: CTS decompression with the WALANT technique resulted in significant cost savings for the national health system, as well as favorable outcomes in terms of satisfaction, anxiety, and pain; the procedure was safe, comfortable, and efficient. The benefits and profitability of employing fewer hospital resources could be further optimized and replicated to result in significant health-care cost savings.
Materials and Methods: Between 2016 and 2022, a descriptive prospective observational study was conducted on patients with a clinical diagnosis of CTS who had undergone surgical treatment. Patient satisfaction was assessed using a questionnaire that asked about pain during different periods of time, anxiety, and the procedure itself. The costs of the anesthetic technique were also analyzed.
Results: 92 patients were evaluated and the majority of them were satisfied with their WALANT experience; 94.5% said they would choose this procedure again, citing low levels of pain and anxiety. A cost reduction of 60.6% per procedure was achieved.
Conclusions: CTS decompression with the WALANT technique resulted in significant cost savings for the national health system, as well as favorable outcomes in terms of satisfaction, anxiety, and pain; the procedure was safe, comfortable, and efficient. The benefits and profitability of employing fewer hospital resources could be further optimized and replicated to result in significant health-care cost savings.
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How to Cite
Ferraguti, M. S. (2024). Patient Experience Evaluation and Cost Savings Analysis of Carpal Tunnel Syndrome Decompression Surgery Using the WALANT Technique. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(3), 246-256. https://doi.org/10.15417/issn.1852-7434.2024.89.3.1840
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Clinical Research
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References
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anesthesia: a prospective cohort study. Hand (NY) 2013;8(1):47-53. https://doi.org/10.1007/s11552-012-9474-5
7. Leblanc MR, Lalonde J, Lalonde DH. A detailed cost and efficiency analysis of performing carpal tunnel surgery in the main operating room versus the ambulatory setting in Canada. Hand (NY) 2007;2(4):173-8.
https://doi.org/10.1007/s11552-007-9043-5
8. Chatterjee A, McCarthy JE, Montagne SA, Leong K, Kerrigan CL. A cost, profit, and efficiency analysis of
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https://doi.org/10.1016/S0363-5023(96)80298-X
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11. McKee DE, Lalonde DH, Thomas A, Glennie DL, Hayward JE. Optimal time delay between epinephrine injection
and incision to minimize bleeding. Plast Reconstr Surg 2013;131(4):811-4. https://doi.org/10.1097/PRS.0b013e3182818ced
12. Lalonde D, Martin A. Epinephrine in local anesthesia in finger and hand surgery: the case for wide-awake
anesthesia. J Am Acad Orthop Surg 2013;21(8):443-7. https://doi.org/10.5435/JAAOS-21-08-443
13. Lalonde D, Bell M, Benoit P, Sparkes G, Denkler K, Chang P. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie Project clinical phase. J Hand Surg Am 2005;30(5):1061-7. https://doi.org/10.1016/j.jhsa.2005.05.006
14. Thomson CJ, Lalonde DH, Denkler KA, Feicht AJ. A critical look at the evidence for and against elective
epinephrine use in the finger. Plast Reconstr Surg 2007;119(1):260-6. https://doi.org/10.1097/01.prs.0000237039.71227.11
15. Lalonde DH. Conceptual origins, current practice, and views of wide awake hand surgery. J Hand Surg Eur Vol
2017;42(9):886-95. https://doi.org/10.1177/1753193417728427
16. Zhang JX, Gray J, Lalonde DH, Nicholas Carr N. Digital necrosis after lidocaine and epinephrine injection in the
flexor tendon sheath without phentolamine rescue. J Hand Surg Am 2017;42(2):e119-e123.
https://doi.org/10.1016/j.jhsa.2016.10.015
17. 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(3):e139-e147. https://doi.org/10.1016/j.jhsa.2016.11.019
18. Gallucci G, Rosa Y, Brandariz R, Cerrutti W, Tanoira I. Túnel carpiano con anestesia local versus WALANT. Rev
Asoc Argent Ortop Traumatol 2022;87(3):335-41. https://doi.org/10.15417/issn.1852-7434.2022.87.3.1430
19. Frank SG, Lalonde DH. How acidic is the lidocaine we are injecting, and how much bicarbonate should we add? Can J Plast Surg 2012;20(2):71-3. https://doi.org/10.1177/229255031202000207
20. Braithwaite BD, Robinson GJ, Burge PD. Haemostasis during carpal tunnel release under local anaesthesia: a
controlled comparison of a tourniquet and adrenaline infiltration. J Hand Surg Br 1993;18(2):184-6.
https://doi.org/10.1016/0266-7681(93)90103-m
21. Teo I, Lam W, Muthayya P, Steele K, Alexander S, Miller G. Patients’ perspective of wide-awake hand
surgery—100 consecutive cases. J Hand Surg Eur Vol 2013;38(9):992-9. https://doi.org/10.1177/1753193412475241
22. Far-Riera AM, Pérez-Uribarri C, Sánchez Jiménez M, Esteras Serrano MJ, Rapariz González JM, Ruiz Hernández
IM. Estudio prospectivo sobre la aplicación de un circuito WALANT para la cirugía del síndrome del túnel carpiano
y dedo en resorte. Rev Esp Cir Ortop Traumatol 2019;63(6):400-7. https://doi.org/10.1016/j.recot.2019.06.006
23. Bismil M, Bismil Q, Harding D, Harris P, Lamyman E, Sansby L. Transition to total one-stop wide-awake hand
surgery service-audit: a retrospective review. JRSM Short Rep 2012;3(4):23. https://doi.org/10.1258/shorts.2012.012019
general population. JAMA 1999;282(2):153-8. https://doi.org/10.1001/jama.282.2.153
2. Lundborg G, Dahlin LB. Anatomy, function, and pathophysiology of peripheral nerves and nerve compression.
Hand Clin 1996;12(2):185-93. PMID: 8724572
3. Kim PT, Lee HJ, Kim TG, Jeon IH. Current approaches for carpal tnnel syndrome. Clin Orthop Surg 2014;6(3):253-7. https://doi.org/10.4055/cios.2014.6.3.25
4. Bland JDP. Treatment of carpal tunnel syndrome. Muscle Nerve 2007;36(2)167-71. https://doi.org/10.1002/mus.20802
5. Lalonde DH, Wong A. Dosage of local anesthesia in wide awake hand surgery. J Hand Surg Am 2013;38(10):2025-8. https://doi.org/10.1016/j.jhsa.2013.07.017
6. Davison PG, Cobb T, Lalonde DH. The patient’s perspective on carpal tunnel surgery related to the type of
anesthesia: a prospective cohort study. Hand (NY) 2013;8(1):47-53. https://doi.org/10.1007/s11552-012-9474-5
7. Leblanc MR, Lalonde J, Lalonde DH. A detailed cost and efficiency analysis of performing carpal tunnel surgery in the main operating room versus the ambulatory setting in Canada. Hand (NY) 2007;2(4):173-8.
https://doi.org/10.1007/s11552-007-9043-5
8. Chatterjee A, McCarthy JE, Montagne SA, Leong K, Kerrigan CL. A cost, profit, and efficiency analysis of
performing carpal tunnel surgery in the operating room versus the clinic setting in the United States. Ann Plast Surg 2011;66(3):245-8. https://doi.org/10.1097/SAP.0b013e3181db7784
9. Campion D. Electrodiagnostic testing in hand surgery. J Hand Surg Am 1996;21(6):947-56.
https://doi.org/10.1016/S0363-5023(96)80298-X
10. Wallace DL, Latimer MD, Belcher HJCR. Stopping warfarin therapy is unnecessary for hand surgery. J Hand Surg Br 2004;29(3):203-5. https://doi.org/10.1016/j.jhsb.2003.12.008
11. McKee DE, Lalonde DH, Thomas A, Glennie DL, Hayward JE. Optimal time delay between epinephrine injection
and incision to minimize bleeding. Plast Reconstr Surg 2013;131(4):811-4. https://doi.org/10.1097/PRS.0b013e3182818ced
12. Lalonde D, Martin A. Epinephrine in local anesthesia in finger and hand surgery: the case for wide-awake
anesthesia. J Am Acad Orthop Surg 2013;21(8):443-7. https://doi.org/10.5435/JAAOS-21-08-443
13. Lalonde D, Bell M, Benoit P, Sparkes G, Denkler K, Chang P. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie Project clinical phase. J Hand Surg Am 2005;30(5):1061-7. https://doi.org/10.1016/j.jhsa.2005.05.006
14. Thomson CJ, Lalonde DH, Denkler KA, Feicht AJ. A critical look at the evidence for and against elective
epinephrine use in the finger. Plast Reconstr Surg 2007;119(1):260-6. https://doi.org/10.1097/01.prs.0000237039.71227.11
15. Lalonde DH. Conceptual origins, current practice, and views of wide awake hand surgery. J Hand Surg Eur Vol
2017;42(9):886-95. https://doi.org/10.1177/1753193417728427
16. Zhang JX, Gray J, Lalonde DH, Nicholas Carr N. Digital necrosis after lidocaine and epinephrine injection in the
flexor tendon sheath without phentolamine rescue. J Hand Surg Am 2017;42(2):e119-e123.
https://doi.org/10.1016/j.jhsa.2016.10.015
17. 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(3):e139-e147. https://doi.org/10.1016/j.jhsa.2016.11.019
18. Gallucci G, Rosa Y, Brandariz R, Cerrutti W, Tanoira I. Túnel carpiano con anestesia local versus WALANT. Rev
Asoc Argent Ortop Traumatol 2022;87(3):335-41. https://doi.org/10.15417/issn.1852-7434.2022.87.3.1430
19. Frank SG, Lalonde DH. How acidic is the lidocaine we are injecting, and how much bicarbonate should we add? Can J Plast Surg 2012;20(2):71-3. https://doi.org/10.1177/229255031202000207
20. Braithwaite BD, Robinson GJ, Burge PD. Haemostasis during carpal tunnel release under local anaesthesia: a
controlled comparison of a tourniquet and adrenaline infiltration. J Hand Surg Br 1993;18(2):184-6.
https://doi.org/10.1016/0266-7681(93)90103-m
21. Teo I, Lam W, Muthayya P, Steele K, Alexander S, Miller G. Patients’ perspective of wide-awake hand
surgery—100 consecutive cases. J Hand Surg Eur Vol 2013;38(9):992-9. https://doi.org/10.1177/1753193412475241
22. Far-Riera AM, Pérez-Uribarri C, Sánchez Jiménez M, Esteras Serrano MJ, Rapariz González JM, Ruiz Hernández
IM. Estudio prospectivo sobre la aplicación de un circuito WALANT para la cirugía del síndrome del túnel carpiano
y dedo en resorte. Rev Esp Cir Ortop Traumatol 2019;63(6):400-7. https://doi.org/10.1016/j.recot.2019.06.006
23. Bismil M, Bismil Q, Harding D, Harris P, Lamyman E, Sansby L. Transition to total one-stop wide-awake hand
surgery service-audit: a retrospective review. JRSM Short Rep 2012;3(4):23. https://doi.org/10.1258/shorts.2012.012019