gms | German Medical Science

Objectives/Interrogation: Hand surgery with Walant becomes more popular for surgeon and a new strategy for hospital. Few data are available for patient agreement and comfort.

Methods: After IRB approval, patients scheduled for Walant hand surgery were prospectively enrolled and evaluated. Surgery was performed in the ambulatory unit using a standard Walant surgery without premedication, monitoring nor intravenous line. Before surgery, evaluations were performed using APAIS score (pre operative anxiety) and Likert scale (for comfort and stress). After surgery, perioperative procedure quality (primary end point) was evaluated using EVAN G scores (at discharge) by an independent evaluator. Times and pain scores (0-10) at each time were recorded (0 to 10). Statistical analyses using SAS software.

Results: 31 patients (12 males, 62±15 years, 56±6 kg, ASA 2±1) were prospectively included. Before procedure, pain score at surgical site was 4±3 with an APAIS score at 9±5 (=very low stress level). Only one patients reported personal high stress level. Pain at infiltration was 2±1. At incision, only 1 patient required more infiltration and 1 patient required a general anesthesia due to surgical complication: WALANT success without anaesthesit rescue was 97 %. Duration of surgery was 11±10 min, no adverse effect was recorded in PACU. Total intra hospital (including infiltration and surgery) stay was 63±29 min. At discharge, EVAN score (median, IQ) for global satisfaction (1 scale: 0-5) was 5 (5-5), comfort (3 scales: 0-15) was 15 (12-15), adverse event (10 scales: 10-50) was 10 (10-14), pain (scales 7: 7-35) was 7 (7-9) No side effect was recorded at discharge, with a mean pain score at 0 (no nausea or vomiting). Chung score at discharge was 12/12 for all patients.

Conclusion: This study demonstrated a very high level of agreement and satisfaction for Walant surgery for the patient (primary end point) and high benefit for the surgeon and hospital, regarding time per procedure.