Abstract
Objective To develop and assess after one year a clinical pathway for hand surgery procedures using the wide awake, local anesthesia, no tourniquet (WALANT) technique.
Materials and Methods We planned and executed clinical pathway for non-complex hand surgery patients and performed a comparative cost assessment between the operating room with all the necessary staff and local surgery with the WALANT technique.
The rate of surgical cancellations and the number of patients operated on were calculated as indicators of quality. The mean length of hospital stay was compared between patients operated on in an ordinary fashion and in the WALANT operating room. We assessed the reduction in the surgical waiting list for carpal tunnel syndrome and trigger finger.
Results Direct costs were 48.9% lower with the WALANT technique. We evaluated 254 patients in 2020 and 339 in 2021. The rate of cancellations was of 5.1% (0.4% for medical reasons). The length of hospital stay was significantly shorter for patients in the WALANT group (z = -8.743; p = 0.000). The decrease in the surgical list was of 113 days.
Conclusions Surgery with the WALANT technique suited for this clinical pathway enables the performance of interventions in patients with less resources, which decreases the direct costs and unburdens the Outpatient Surgery Units.
Keywords
local anesthesia - WALANT - clinical pathway - major outpatient surgery
