Document Type

Conference Proceeding

Publication Date

3-8-2023

Abstract

INTRODUCTION: There is a growing body of literature supporting the efficacy, safety, and benefits of wide awake office-based low risk hand surgery. Procedures such as a carpal tunnel release are now, under the right clinical circumstances, being performed in the office-setting as opposed to a traditional operating room. While there is growing evidence supporting technique, procedure room setup, and cost analyses of office-based surgery, there is little investigation into the public perceptions of having surgery done in the office. Here we sought to evaluate public perceptions of undergoing low risk hand surgery in the office setting. METHODS: A prospective survey study was performed utilizing a 33-question, paid, survey distributed via a clinically, validated, public, online marketplace. After collecting baseline demographics, participants were queried regarding their perceptions of undergoing low risk hand surgery in their surgeon’s office and divided into 3 cohorts: In-Office Surgery (IOS), No InOffice Surgery (NIOS), or No Preference (NP). Educational material was integrated into the survey providing comparisons of three possible surgery locations (Figure 1). We also provided specific procedural scenarios (trigger finger release, mucoid cyst removal, carpal tunnel syndrome, and a distal radius fracture) to better assess understanding and comfortability with office-based surgery. The data was then analyzed using t-test unpaired and chi square analyses were performed. RESULTS: There were 509 respondents to the survey. These were divided into three groups based on their initial answer to a question asking if the respondent would be open to low risk hand surgery in the office setting. There were 266 (52%) in the IOS group, 104 (20%) in the NIOS group, and 139 (27%) in the NP group. There were no statistically significant differences in respondent demographics across the study groups (Table 1). There was a statistically significant difference between those with a history of prior hand surgery or surgery at an ambulatory surgery center and those in the IOS group (p<0.0001). Only 50/104 in the NIOS group realized in-office surgery was a legitimate option compared to 239/266 in the IOS group (p<0.0001). After the brief education block (Figure 1), 50/139 NP group switched to agreement with in-office surgery. In terms or procedure specific questioning, the IOS group favored Trigger Finger Release (51%) and Mucoid Cyst Removal (65%) while 74% favored ambulatory surgery center with sedation for open treatment of a distal radius fracture (Table 2). The most influential factors determining surgical location were comfort during the procedure and total encounter time which was significant across groups (p<0.0001). Lastly, the IOS group overall favored the location of surgery be at the surgeon’s discretion more so than the NIOS group (p<0.0001). DISCUSSION AND CONCLUSION: This study suggests that in-office, low risk, hand surgery has the opportunity to be well-received by the public. In this study cohort, approximately 79% of participants either agreed (52%) with in-office surgery or had no preference (27%) illustrating an opportunity for in-office surgery. It is clear that the public perceptions of in-office surgery are multifactorial, however, for certain low-risk procedures such as trigger finger release and mucoid cyst removal in the office it is a viable option in the eye of the public. More research is needed to better understand the public’s perception of in-office hand surgery which will also further our ability to provide for our patients.

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American Academy of Orthopaedic Surgeons AAOS 2023 Annual Meeting, March 7-11, 2023, Las Vegas, NV

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