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Wide Awake Surgery of the Hand (WASH): a cost saving technique
Fadi Nukta, MD1, Mark Albert, MD2.
1NOVA Plastic Surgery, Reston, VA, USA, 2University of Massachusetts, Worcester, MA, USA.

BACKGROUND:
Traditionally, hand surgery has been performed while using a tourniquet which usually requires the use of intravenous sedation in order to alleviate the discomfort of the high pressure cuff. Wide Awake Surgery of the Hand (WASH) is a technique that utilizes local anesthesia with epinephrine in order to be able to perform the surgery without a tourniquet and therefore the need for sedation. This purpose of this study was to determine the savings achieved by utilizing this technique.
METHODS:
We searched the medical records and the bills for patients who underwent the following procedures (Carpal tunnel, Trigger fingers, tendon repairs, Metacarpal fractures, ganglion cysts, and tendon transfers). Patients were divided into 2 groups. A control group that underwent traditional hand surgery and a second group that consisted of the WASH group. Anesthesia fees and facility fees, which included recovery room fees, OR fees and instruments were compared between the 2 groups.
RESULTS:
The control group consisted of 47 patients while the WASH group consisted on 20 patients. The average anesthesia fees for the control group and the WASH group were $ 1811, and $0 respectively. The average facility fees for the control group and the WASH group were $2942 $ 1681 respectively. This showed a 65% reduction in the cost of anesthesia and facility fees. 6 patients underwent 2 separate procedures on different dates one was with traditional hand surgery and one was using WASH, all these patients indicated in a survey that they preferred the WASH technique and would recommend it to friends and family. In the WASH group: the average level of pain during the injection was 2, while the level during the procedure was zero. 19/20 patients reported that they would have hand surgery under WASH again.
CONCLUSIONS:
WASH is a technique that can provide significant reduction in the costs of hand surgery while still ensuring patient satisfaction. WASH alleviates the need for preoperative testing, over night fasting and enables the surgeon to test the tension of tendon transfers, the rigidity of bony fixation, and any tendon gapping by examining awake patients performing active full range of motion.


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