A Detailed Cost and Efficiency Analysis of the Walant Technique of A1 Pulley Release for the Management of Trigger Finger in a Procedure Room of a Major City Hospital

Background:

The “Wide Awake Local Anesthesia No Tourniquet” (WALANT) technique is being increasingly applied to hand surgery owing to its benefits of decreased patient discomfort, reduced cost, shorter hospital stay, improved patient safety, and the ability to perform active intraoperative examinations. The aim of our study is to analyze the cost savings and efficiency of performing A1 pulley release for treatment of trigger finger using the WALANT technique in a major city hospital procedure room as compared with the standard tourniquet, operating room approach.

Methods:

Patients who underwent trigger finger release either in the main hospital operating room or procedure room between 2012-2017 were identified. Both paper and electronic medical records were reviewed and demographics collected including age, BMI, smoking status, medical comorbidities, and chief complaint with any prior conservative management noted. Additionally, procedural information was obtained including date of surgery, procedure site and length of operation, amount of local anesthesia used, turnover time, and cost of supplies. Patients were followed for an average of 82 days in the procedure room group and 242 days in the operating room group, with post-operative complications noted.

Results:

Thirty-nine procedure room and 37 operating room patients undergoing A1 pulley release were identified from October 2012 to April 2017. Patients in the procedure room received solely local anesthesia, while patients in the operating room received local anesthesia, MAC, or general endotracheal or LMA intubation. In both the procedure room and operating room, each finger requiring release was treated with roughly 7.6 cc of local anesthetic.

Cases performed in the procedure room were of overall similar duration to those performed in the main operating room (21.4 ± 7 minutes vs. 23.5 ± 14.3 minutes, respectively; p = .942). However, procedure room cases had an overall shorter room turnover time compared to the main operating room (31.1 ± 11.1 minutes vs. 65.3 ± 17.7 minutes respectively; p < .001).

Additionally, costs of both OR time and instruments were significantly less in the procedure room as compared to the main OR. The cost of the instrument tray utilized for trigger finger release was calculated as $3,304.25 in the main OR and $993.79 in the procedure room. Cost per minute for all personal services in the operating room, including anesthesia and nursing services, was calculated to be $44/minute, a cost that was virtually absent in the procedure room. Lastly, there was no difference in complication rates between the two groups.

Conclusion:

We conclude that performing A1 pulley release for treatment of trigger finger using the WALANT technique is both cost effective and time efficient compared to performing the same procedure in the main OR of a major city public hospital.