Most Proposed Topic :
Clinical Safety and Quality Service I (projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors: (including presenting author): :
Yip KYE(1), Chan PT(1), Tsang KH(2), Lam YY(1), Yeung CM(1), Kwok PP(1), Chui SK(3), Wun YC(1)
Affiliation: :
(1)Department of Orthopaedics and Traumatology, Tuen Mun Hospital, NTWC (2)Department of Orthopaedics and Traumatology, Pok Oi Hospital, NTWC (3)Department of Orthopaedics and Traumatology, Tin Shui Wai Hospital, NTWC
Introduction: :
Upper limb tendon surgeries are traditionally performed under general anaesthesia or plexus anaesthesia (GA/PA) for anaethetic effect at the surgical site and tourniquet site. In the recent decade, wide awake local anaesthesia no tourniquet (WALANT) technique has been widely adopted by hand surgeons. WALANT technique can transform a GA/PA tendon surgery which originally requires peri-operative anaethethist input and a main operating theatre usage to an ambulatory procedure in minor procedure room setting without anaethethists. Numerus benefits of WALANT surgery regarding its efficiency and cost-effectiveness have been reported in the literatures.
Objectives: :
This study aims to review the benefit of WALANT technique compared to traditional GA/PA for major upper limb tendon surgeries, with the outcome on reduction in total floor time and length of stay (LOS) in performing tendon surgeries of the same complexity.
Methodology: :
Retrospective review of the process and outcome of patients who underwent elective upper limb tendon surgeries in NTWC in 2020-2023. Two groups of patients - WALANT versus GA/PA, were compared for their demographics, complexity of procedure, total floor time, LOS and outcome.
Result & Outcome: :
There were 172 elective upper limb tendon surgeries performed: 33 WALANT and 139 GA/PA. WALANT surgeries has significant reduction by 40% in total floor time compared to GA/PA due to decreased time of anaesthesia and recovery room monitoring. The cost of GA/PA arising from personnel expenditure of anaesthetists, operative cost of anaesthetic agents and equipment were eliminated. The average LOS for WALANT group was significantly reduced (1.4 days in WALANT versus 7.3 days in GA/PA group). Most WALANT surgeries were performed as day procedure and hence reduced bed occupancy. The outcome of WALANT and GA/PA surgeries were comparable. There was no pain or intolerant of surgery for WALANT group patients, and no complication was reported intra-operatively. There were additional advantage of intra-operative dynamic assessment during wide awake operation, which allows real-time assessment of tendon gliding, tensioning and adequacy of tenolysis. WALANT technique for upper limb tendon surgery could reduce theater floor time, LOS, eliminate GA/PA cost with comparable outcomes. The application of WALANT surgery can be extended to significant number of emergency operations such as wound exploration, tendon and nerve repair, fracture fixation in the hand and wrist. This more efficient and cost-effective practice shall be adopted in the new service model for ambulatory emergency and elective operations.
