Tooley Trevor R, Feng James E, Mouzaihem Hassan, Khan Jannat M, Bohr Margaret C, Rohde Rachel S
Department of Orthopedic Surgery, Corewell Health East William Beaumont University Hospital, Royal Oak, MI.
Department of General Surgery, Corewell Health East William Beaumont University Hospital, Royal Oak, MI.
J Hand Surg Glob Online. 2024 Jun 11;6(5):619-626. doi: 10.1016/j.jhsg.2024.05.001. eCollection 2024 Sep.
There is growing evidence for the safety of wide-awake, office-based, low-risk hand surgery. However, there is limited insight into patient receptiveness to these procedures. Here, we evaluate the public perceptions and degree of tolerance of low-risk, office-based hand surgery.
A prospective study was performed using a 26-question, paid survey via a clinically validated, public, online marketplace. Participants were divided based on (pre-education) perceptions of in-office hand surgery into three cohorts as follows: in-office surgery (IOS), no in-office surgery, or no preference (NP). Educational material was then presented comparing three surgical settings and anesthetic types. Then, participants selected their setting/anesthetic preferences for the following four procedures: trigger finger release, cyst excision, carpal tunnel release, and distal radius fracture. Statistical analyses with unpaired tests and chi-square tests were performed. < .05 was significant.
There were 509 respondents-266 in the IOS group, 104 in the no in-office surgery group, and 139 in the NP group. Previous outpatient surgery was most frequent in the IOS cohort. In-office surgery and NP cohorts were more likely to believe that surgical procedures could be performed in the clinic setting. The remaining demographics were similar across cohorts. After reviewing the education graphic, 50 of the 139 in the NP group switched to prefer IOS. For procedure-specific questioning, 40.6% (207/509) were amenable to in-office trigger finger release and 58.3% (297/509) for cyst excision, unlike more invasive procedures (carpal tunnel release: 25.6% (130/509); distal radius fracture: 9.8% (50/509). The most influential factors determining surgical location were comfort during the procedure and total encounter time. The IOS group favored location to be at the surgeon's discretion more than the no in-office surgery group.
In-office, low-risk, hand surgery appears desirable to select patients. If presented with the option for in-office trigger finger release or cyst excision, approximately 40.6% (207/509) and 58.3% (297/509), respectively, may be amenable to IOS.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prospective IB.
越来越多的证据表明，在清醒状态下、门诊进行的低风险手部手术是安全的。然而，对于患者对这些手术的接受程度了解有限。在此，我们评估公众对低风险门诊手部手术的认知和耐受程度。
通过一个经过临床验证的公开在线市场进行了一项前瞻性研究，采用了一份有26个问题的付费调查问卷。参与者根据（术前教育）对门诊手部手术的认知被分为三个队列，如下：门诊手术（IOS）组、非门诊手术组或无偏好（NP）组。随后展示了比较三种手术环境和麻醉类型的教育材料。然后，参与者为以下四种手术选择他们偏好的手术环境/麻醉方式：扳机指松解术、囊肿切除术、腕管松解术和桡骨远端骨折手术。进行了非配对t检验和卡方检验的统计分析。P <.05具有统计学意义。
共有509名受访者——IOS组266人，非门诊手术组104人，NP组139人。IOS队列中既往门诊手术最为常见。门诊手术组和NP队列更有可能认为手术可以在门诊环境中进行。其余人口统计学特征在各队列中相似。在查看教育图表后，NP组139人中的50人转而偏好IOS。对于特定手术的提问，40.6%（207/509）的人愿意接受门诊扳机指松解术，58.3%（297/509）的人愿意接受囊肿切除术，这与侵袭性更强的手术不同（腕管松解术：25.6%（130/509）；桡骨远端骨折手术：9.8%（50/509））。决定手术地点的最有影响力因素是手术过程中的舒适度和总就诊时间。IOS组比非门诊手术组更倾向于由外科医生自行决定手术地点。
门诊低风险手部手术似乎受到部分患者的青睐。如果有门诊扳机指松解术或囊肿切除术可供选择，分别约有40.6%（207/509）和58.3%（297/509）的人可能愿意接受门诊手术。
研究类型/证据水平：前瞻性二级证据。
