The Use of the Procedure Room for Wide-Awake Local Anesthesia, No Tourniquet Hand Surgery in "High-Risk" Patients.

Purpose: To study if patients who would be deemed high-risk individuals by traditional classifications of American Society of Anesthesiologists (ASA) or the updated guidelines of ASA Practice Advisory (ASAPA) can safely undergo surgery under wide-awake local anesthesia, no tourniquet in a procedure room setting without any increased risks of complications.

Methods: We analyzed 436 surgeries performed in our procedure room over a 4-year period. No medical comorbidities precluded a patient from surgery within the procedure room, and no preoperative clearance was required. All patients were risk-stratified based on two classifications systems: ASA and ASAPA recommendations. Complications were documented. Patients were categorized into a surgical site infection (SSI) cohort and a non-SSI cohort. Mann-Whitney Wilcoxon and chi-square analyses were used to detect differences between cohorts.

Results: The prevalence of SSI was six out of 437 (1.4%). Our total complication rate (mass recurrence, need for additional surgery, etc.) was 12 out of 425 (2.7%). The number of patients within each risk classification was similar. Patient characteristics were similar on the basis of age, body mass index, smoking status, or presence of diabetes. The ASA or ASAPA classification did not show a relationship to complications. Additionally, no patients were transferred to the emergency department or admitted overnight after their procedures.

Conclusions: Our study demonstrated a complication rate of 2.7% for hand surgery procedures performed in the procedure room setting. Using standardized measures of anesthetic risk related to comorbidities, this study showed that there was no increase in complications for high-risk patients who had surgeries performed in the procedure room.

Type of study/level of evidence: Prognosis IV.