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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 Mar; 42(3):e139-e147.JH

Abstract

PURPOSE

Wide-awake, local anesthesia, no tourniquet (WALANT) hand surgery was developed to improve access to hand surgery care while optimizing medical resources. Hand surgery in the clinic setting may result in substantial cost savings for the United States Military Health Care System (MHS) and provide a safe alternative to performing similar procedures in the operating room.

METHODS

A prospective cohort study was performed on the first 100 consecutive clinic-based WALANT hand surgery procedures performed at a military medical center from January 2014 to September 2015 by a single hand surgeon. Cost savings analysis was performed by using the Medical Expense and Performance Reporting System, the standard cost accounting system for the MHS, to compare procedures performed in the clinic versus the operating room during the study period. A study specific questionnaire was obtained for 66 procedures to evaluate the patient's experience.

RESULTS

For carpal tunnel release (n = 34) and A1 pulley release (n = 33), there were 85% and 70% cost savings by having the procedures performed in clinic under WALANT compared with the main operating room, respectively. During the study period, carpal tunnel release, A1 pulley release, and de Quervain release performed in the clinic instead of the operating room amounted to $393,100 in cost savings for the MHS. There were no adverse events during the WALANT procedure.

CONCLUSIONS

A clinic-based WALANT hand surgery program at a military medical center results in considerable cost savings for the MHS.

TYPE OF STUDY/LEVEL OF EVIDENCE

Economic/Decision Analysis IV.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28011033

Citation

Rhee, Peter C., et al. "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." The Journal of Hand Surgery, vol. 42, no. 3, 2017, pp. e139-e147.
Rhee PC, Fischer MM, Rhee LS, et al. 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.
Rhee, P. C., Fischer, M. M., Rhee, L. S., McMillan, H., & Johnson, A. E. (2017). 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. The Journal of Hand Surgery, 42(3), e139-e147. https://doi.org/10.1016/j.jhsa.2016.11.019
Rhee PC, et al. 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. PubMed PMID: 28011033.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Rhee,Peter C, AU - Fischer,Michelle M, AU - Rhee,Laura S, AU - McMillan,Ha, AU - Johnson,Anthony E, Y1 - 2016/12/20/ PY - 2016/03/21/received PY - 2016/11/09/revised PY - 2016/11/10/accepted PY - 2016/12/25/pubmed PY - 2017/12/30/medline PY - 2016/12/25/entrez KW - WALANT KW - Wide-awake hand surgery KW - carpal tunnel release KW - clinic-based hand surgery KW - trigger finger release SP - e139 EP - e147 JF - The Journal of hand surgery JO - J Hand Surg Am VL - 42 IS - 3 N2 - PURPOSE: Wide-awake, local anesthesia, no tourniquet (WALANT) hand surgery was developed to improve access to hand surgery care while optimizing medical resources. Hand surgery in the clinic setting may result in substantial cost savings for the United States Military Health Care System (MHS) and provide a safe alternative to performing similar procedures in the operating room. METHODS: A prospective cohort study was performed on the first 100 consecutive clinic-based WALANT hand surgery procedures performed at a military medical center from January 2014 to September 2015 by a single hand surgeon. Cost savings analysis was performed by using the Medical Expense and Performance Reporting System, the standard cost accounting system for the MHS, to compare procedures performed in the clinic versus the operating room during the study period. A study specific questionnaire was obtained for 66 procedures to evaluate the patient's experience. RESULTS: For carpal tunnel release (n = 34) and A1 pulley release (n = 33), there were 85% and 70% cost savings by having the procedures performed in clinic under WALANT compared with the main operating room, respectively. During the study period, carpal tunnel release, A1 pulley release, and de Quervain release performed in the clinic instead of the operating room amounted to $393,100 in cost savings for the MHS. There were no adverse events during the WALANT procedure. CONCLUSIONS: A clinic-based WALANT hand surgery program at a military medical center results in considerable cost savings for the MHS. TYPE OF STUDY/LEVEL OF EVIDENCE: Economic/Decision Analysis IV. SN - 1531-6564 UR - https://www.unboundmedicine.com/medline/citation/28011033/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_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0363-5023(16)30999-6 DB - PRIME DP - Unbound Medicine ER -