Doctors have streamlined the Wide-Awake Hand Surgery at the Salisbury VA to allow 12 patients to have the minor procedure every Friday morning. Most of the procedures take between 5 and 15 minutes to perform under local anesthesia.
Minor hand surgeries performed using this method include carpal tunnel releases, trigger finger releases, ganglion excisions and De Quervaine releases. Also Dupuytren’s releases, tennis elbow surgery and ulnar nerve releases at the wrist.
The advantage of the procedure is the patient does not require general anesthesia to undergo surgery. Patients enter the procedure room fully clothed and undergo local numbing medication to the affected area only.
After the procedure, patients are given post-op instructions and can leave the procedure room unassisted. Patients do not need a driver if they are having surgery on only one hand. They also can eat and drink before surgery. The surgeries do not require antibiotics because they are all soft tissue procedures.
No IVs or medications are needed prior to the procedure. The environment is very interpersonal as surgeons and staff talk with the patient throughout the procedure. The procedure eliminates the use of narcotics because the patient is awake and realizes how quick and simple the procedure is.
Surgery introduced in 2016
Dr. Jeffrey A. Baker, a hand and upper extremity specialist, introduced the relatively new technique called ‘Wide-Awake Hand Surgery’ to Salisbury VA in November of 2016.
Using this technique at the Salisbury VA Medical Center has greatly helped improve access for our Veterans. Yet very few orthopedic surgeons have adapted their hand practices to this technique.
Dr. Baker believes Salisbury VA is the first clinic that is able to complete 12 cases between 7:30 a.m. and 1:00 p.m. Salisbury VA was able to perform surgery on 349 Veterans over the last year with no complications. Dr. Baker anticipates this number will increase.
A 2017 scientific article on the “Wide-Awake Hand Surgery Program at a Military Medical Center” showed that with just 100 patients, there was a 75-80% savings in the cost of surgery. The total cost savings were around $393,100 for the 100 procedures, compared to performing these procedures in the regular OR.
Veterans who have undergone Wide-Awake Hand Surgery at the Salisbury VA have expressed extreme satisfaction with the technique. Dr. Baker strongly feels other VA facilities, with practice and very little additional cost, also could easily implement the procedure.
Amanda Reilly is a public affairs specialist with the Salisbury VA Health Care System.