O'Brien Devon M, Francoisse Caitlin A, Nicholson Luke T
From the Department of Orthopaedic Surgery, Keck School of Medicine of USC (Ms. O'Brien, Dr. Francoisse, and Dr. Nicholson), and the Department of Orthopaedic Surgery, Los Angeles General Medical Center, Los Angeles, CA (Dr. Francoisse and Dr. Nicholson).
J Am Acad Orthop Surg Glob Res Rev. 2025 Jul 2;9(7). doi: 10.5435/JAAOSGlobal-D-25-00159. eCollection 2025 Jul 1.
Minor hand surgeries are increasingly being performed in procedure rooms (PRs) rather than operating rooms (ORs). We aimed to determine the safety of PR-based hand surgeries at an urban safety-net hospital among an underserved patient population.
An institutional review board-approved retrospective review of PR-based hand surgeries from January 2022 to February 2024 was conducted. Patient demographics, comorbidities, surgery details, and complications were collected. Fisher exact test analyses were conducted with significant P value <0.05. Data analyses for race and insurance type were excluded because of lack of heterogeneity (>99% underrepresented racial groups, 100% public insurance).
Of 202 surgical encounters, the most common surgeries were carpal tunnel release (n = 108, 46.4%), trigger finger release (n = 65, 27.9%), and mass excision (n = 37, 15.9%). Most patients (n = 184, 91.1%) had no postoperative complications. Among patients with postoperative complications, 90.5% were minor (i.e., pillar pain, catching/locking). The major postoperative complications included complex regional pain syndrome (n = 1, 0.5%) and deep surgical site infection (n = 1, 0.05%) requiring hospitalization for intravenous antibiotics and irrigation and débridement in the ORs. No other cases involved infection, hospitalization, or revision surgery. No intraoperative complications or death occurred. No significant difference was noted in postoperative complications based on language preference (P = 0.999).
PR-based minor hand surgeries demonstrate low complication rates at an urban safety-net hospital, suggesting safety among this specific underserved population. Additional research should explore multicenter cohorts to identify complication risk factors and aid in surgical decision making for vulnerable groups.
小型手部手术越来越多地在手术间（PRs）而非手术室（ORs）进行。我们旨在确定在一家城市安全网医院为服务不足的患者群体开展的基于手术间的手部手术的安全性。
对2022年1月至2024年2月基于手术间的手部手术进行了一项经机构审查委员会批准的回顾性研究。收集了患者的人口统计学资料、合并症、手术细节和并发症。采用Fisher精确检验分析，显著P值<0.05。由于缺乏异质性（代表性不足的种族群体>99%，公共保险100%），未对种族和保险类型进行数据分析。
在202例手术中，最常见的手术是腕管松解术（n = 108，46.4%）、扳机指松解术（n = 65，27.9%）和肿物切除术（n = 37，15.9%）。大多数患者（n = 184，91.1%）没有术后并发症。在有术后并发症的患者中，90.5%为轻微并发症（即柱状疼痛、卡顿/锁定）。主要的术后并发症包括复杂性区域疼痛综合征（n = 1，0.5%）和深部手术部位感染（n = 1，0.05%），后者需要住院接受静脉抗生素治疗，并在手术室进行冲洗和清创。没有其他病例涉及感染、住院或翻修手术。没有发生术中并发症或死亡。根据语言偏好，术后并发症无显著差异（P = 0.999）。
在一家城市安全网医院，基于手术间的小型手部手术并发症发生率较低，表明在这一特定的服务不足人群中具有安全性。进一步的研究应探索多中心队列，以确定并发症的危险因素，并帮助弱势群体进行手术决策。
