Abstract
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.
Keywords
complications - Dupuytren's contracture - evidence-based medicine - hand infection
- trigger finger
