Are In-Office Procedures Under Local Anesthesia A Feasible Alternative To Ambulatory Surgery For Pediatric Patients?
Nissim Hazkour BA1; Jose Palacios BS2; Paige Goote MD3; Maissa Trabilsy MA1;Inkyu Kang BS2; Nicholas Bastidas MD3
1 SUNY Downstate College of Medicine, Brooklyn, NY, USA2 Donald & Barbara Zucker School of Medicine at Hofstra University/Northwell, Hempstead, NY, USA3 Division of Plastic and Reconstructive Surgery, Northwell Health, Great Neck, NY, USA.
Background: The merit of office pediatric procedures under local anesthesia (IO) depends on their safety and feasibility. Many assume that younger children, particularly aged less than 10, do not tolerate IO procedures due to anxiety, making it challenging to maintain safety and efficacy. However, a risk benefit analysis is necessary to corroborate this.
Methods: A retrospective review assessed outcomes of 864 children who underwent procedures by one plastic surgeon from 2017-2021. Office procedure settings are prepared by offering children video and audio distraction, parental comfort, and reward for remaining calm. Procedures include: branchial vestige, polydactyly, hemangioma, nevus, pilomatrixoma, and branchial cyst removal. Procedure location, past medical and surgical history, time between initial consult and procedure, and anesthetic complication types were recorded.
Results: 751 children (mean age:3.8y) had procedures done IO under local anesthesia, and 113 (4.5y) had them done under general anesthesia in ambulatory surgery (AS). 71% (536) of the IO children were younger than 10 years, with 290 of them aged between 1-6. The pediatric IO and AS groups were statistically similar in terms of sex, age, ICD codes, number of comorbidities and pervious surgeries. Of the 464 benign masses that were removed IO, 25% were between 2-4cm in size and 25% were greater than 4cm. 48% of all masses that were removed IO were located on the face, with 30% of the facial masses sized greater than 3cm. With regards to safety, the complication rates of pediatric AS patients and IO patients were statistically similar. Furthermore, there was no significant association between complication rate and increasing mass size or mass location. In terms of feasibility, no parent requested abortion of any ongoing pediatric IO procedure, and none requested a switch from IO to AS for second stage and revision surgeries. Furthermore, the IO group had an average time from consultation to procedure of 26 days, significantly less than the 68 days of the AS group. The IO group averaged significantly fewer clinic follow up visits (1.8) compared to the AS group (2.9). Surgeons stand to gain time due to bypassing variables like OR turnover, while saving patients money.
Conclusion: IO procedures are equally safe for children as AS procedures. Furthermore, IO removal is feasible with proper preparation of setting. IO removal saves patients significant time, while decreasing cost. IO removal offers physicians time flexibility which may maximize CPT codes billed/year.
Back to 2022 Abstracts