法国公立医院中腕管松解术采用清醒局部麻醉无止血带（WALANT）与腋路臂丛阻滞的比较：护理路径和手术室成本。
Wide awake local anesthesia no tourniquet (WALANT) versus axillary brachial plexus block for carpal tunnel release in a French public university hospital: Care pathways and operating room costs.
机构信息
Service de chirurgie orthopédique et traumatologique, hôpitaux Bichat et Beaujon, université de Paris, Assistance publique des Hôpitaux de Paris, Paris, France.
Service de chirurgie orthopédique et traumatologique, hôpitaux Bichat et Beaujon, université de Paris, Assistance publique des Hôpitaux de Paris, Paris, France.
出版信息
Orthop Traumatol Surg Res. 2023 May;109(3):103358. doi: 10.1016/j.otsr.2022.103358. Epub 2022 Jun 30.
INTRODUCTION
The wide awake local anesthesia no tourniquet (WALANT) is a local anesthetic technique that theoretically cuts costs and shortens surgical waiting times, but this has yet to be demonstrated in France. The main objective of this study was to assess and compare the comprehensive care pathways and costs of performing carpal tunnel release (CTR) procedures in the ambulatory surgery unit using WALANT and axillary brachial plexus block (ABPB).
METHODS
A total of 72 CTRs in 66 patients were reviewed after a minimum follow-up of 6 months. The anesthesia was performed by an anesthesiologist after a preoperative consultation. The surgical waiting time, operating room occupancy time, total time taken off work (TOW) and the return to work rate were recorded. The estimated total direct cost per patient (TDCPP) was the sum of the specialist consultation fees, the French diagnosis-related group (DRG) rates and the minimum daily cost of TOW (€27.30/day).
RESULTS
Only the total operating room occupancy time differed significantly: 27minutes for the WALANT versus 37minutes for the ABPB (p=0.004). There were no complications or reoperations in either group. The total cost for the cohort was estimated at €190,970. The mean estimated TDCPP was €2,870 for the entire cohort, €2,543 for the ABPB and €2,713 for the WALANT (p=0.791). Twenty-seven of the 45 patients returned to work after a mean TOW of 3.1 months. Fourteen CTRs were preceded by a mean preoperative TOW of 27 days, which resulted in a cost of €24,948 (13% of the total cost). There were no significant differences in TOW or revision rate between WALANT and ABPB.
CONCLUSION
Although WALANT significantly reduced operating room occupancy times in our public hospital, the societal costs were the same regardless of the anesthesia technique. Reducing surgical waiting times in France could result in a theoretical saving of nearly €14 million annually.
LEVEL OF EVIDENCE
IV.
简介
清醒局部麻醉无止血带（WALANT）是一种局部麻醉技术，理论上可以降低成本并缩短手术等待时间，但这尚未在法国得到证实。本研究的主要目的是评估和比较在日间手术病房中使用 WALANT 和腋路臂丛阻滞（ABPB）进行腕管松解术（CTR）的综合护理路径和成本。
方法
对 72 例接受 WALANT 和 ABPB 麻醉的 66 例患者进行了最少 6 个月的随访后进行了回顾性分析。麻醉由麻醉医师在术前咨询后进行。记录手术等待时间、手术室占用时间、总停工时间（TOW）和复工率。每位患者的估计总直接成本（TDCPP）为专家咨询费、法国诊断相关组（DRG）费率和 TOW 最低日费用（€27.30/天）之和。
结果
仅总手术室占用时间差异有统计学意义：WALANT 组为 27 分钟，ABPB 组为 37 分钟（p=0.004）。两组均无并发症或再次手术。该队列的总费用估计为€190970。整个队列的平均估计 TDCPP 为€2870，ABPB 组为€2543，WALANT 组为€2713（p=0.791）。45 例患者中有 27 例在平均 TOW 3.1 个月后复工。14 例 CTR 术前平均停工时间为 27 天，导致费用为€24948（占总成本的 13%）。WALANT 和 ABPB 之间 TOW 或翻修率无显著差异。
结论
尽管 WALANT 显著缩短了我们公立医院的手术室占用时间，但无论采用何种麻醉技术，社会成本都是相同的。如果减少法国的手术等待时间，每年可能会节省近 1400 万欧元。
证据等级
IV。
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