Imagine a surgery you can walk in and out of in less than an hour, fully awake, and drive to work. Now imagine this surgery costs you and your insurance company thousands of dollars less.
Imagine that you do not have to go through general anesthesia, allowing you to talk to your surgeon about your condition and restrictions during surgery.
While relatively unknown, wide-awake, in-office hand surgery presents an opportunity to revolutionize the field of hand surgery. Transitioning from the hospital to the office, asleep to awake, and general to local anesthesia, in-office hand surgery dramatically reduces costs, reduces complications, and improves patient satisfaction. This technique began in Canada, where Dr. Donald Lalonde studied the outcomes of over 50,000 successful hand surgeries performed in his office. His findings changed the field of hand surgery.
Formal hospital operating rooms are unquestionably necessary for more complex procedures, such as open heart surgeries or total hip replacements.
But, not all surgeries are the same. Dr. Lalonde proved that avoiding the formal hospital setting actually decreased complications when performing smaller, soft tissue procedures. How? As it turns out, more complications arise from general anesthesia than from the actual procedure.
While infection risks are similar with both techniques, wide-awake surgery avoids complications due to IV placement and general sedation. These include nerve damage, blood clots, nausea, vomiting, sore throats due to a breathing tube, and cognitive impairment among others.
Avoiding general anesthesia is particularly important for patients with medical conditions such as heart disease or diabetes, many of whom are simply too high risk to undergo traditional surgery.
Additionally, surgery cost is drastically reduced by avoiding a hospital operating room. In a recent study in The Journal of Hand Surgery, in-office carpal tunnel release procedures reduced traditional surgery costs by 85%. Considering how common this condition is, the total cost savings of transitioning this procedure out of operating rooms, would be measured in billions of dollars annually.
The in-office hand surgery approach is well-received by patients, who have reported that the pain of the operation was comparable to or even less painful than a routine dental procedure. A study performed at the Hand to Shoulder Center in Fort Worth reported that 95% of patients say that if they had to repeat the same procedure, they would prefer the in-office, wide-awake approach as opposed to the traditional operating room.
Despite the obvious advantages of in-office wide-awake surgeries, this technique is offered by very few surgeons in Fort Worth and the country as a whole. The reason is simple. Surgeons are not reimbursed by insurance companies to cover the costs of offering in-office procedures. These costs include purchasing necessary instruments, medications, sterilization equipment, and dedicated office space. Hand surgeons frequently lose money by offering this valuable service.
This lack of incentivization doesn’t make sense. As healthcare costs rise and access to care continues to become more limited, our healthcare system must evolve.
All of us can make a difference in this initiative. Seek out in-office hand surgeries. Look for smart and safe alternatives. Talk to primary care providers and ask them where to find surgeons offering in-office procedures. Attempting to change the status quo is difficult, but it can be an important step in helping us create a more affordable, efficient, and safer healthcare system. It is time for insurance providers and patients alike to seek out wide-awake, in-office hand surgeries, as this elegant solution to a pervasive problem can improve healthcare for thousands of people across the United States.
Sage Copling is a senior at the University of North Carolina at Chapel Hill studying Quantitative Biology and Neuroscience, and has interests in nanoparticle drug delivery, public health, and science journalism.
Sai Sarnala is a Vagelos Molecular Life Sciences Scholar at the University of Pennsylvania, studying Biochemistry and Biophysics, and has interests in science journalism and global health.
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