Creating an Outpatient, Local Anesthetic Hand Operating Room in a Resource-Constrained Ghanaian Hospital Builds...

Area of Science:

• Orthopedics and Traumatology
• Surgical Capacity Building
• Global Health

Background:

• Expanding surgical capacity in resource-constrained nations is challenging due to financial and infrastructure limitations.
• Existing operating room time constraints lead to postponements, particularly impacting hand surgery which is crucial for patient function and return to work.
• Hand surgery can potentially be performed with local anesthesia in a basic procedure room, bypassing the need for an operating room and anesthesiologist.

Purpose of the Study:

• To evaluate the feasibility and impact of establishing a dedicated procedure room for hand surgery under local anesthesia in a low-income country.
• To determine if this model can significantly increase hand surgery capacity and reduce costs.

Main Methods:

• A procedure room previously used for storage was repurposed at Komfo Anokye Teaching Hospital, Ghana.
• A surgeon trained in wide-awake local anesthesia no tourniquet (WALANT) technique provided training and conducted procedures.
• Data on case volume, types of procedures, and cost savings were collected over the first 11 months of operation (2017).

Main Results:

• The procedure room increased surgical capacity by an average of 33 cases per month, totaling 358 cases (240 hand surgeries) in 11 months.
• Hand surgeries included wound washouts, tendon repairs, fracture pinning, amputations, trigger finger repairs, and nerve repairs.
• Cost savings per case ranged from US $100 to $400, with timely reimbursement directly from patients.

Conclusions:

• A dedicated procedure room for WALANT hand surgery is efficient, cost-effective, and significantly boosts surgical capacity in resource-limited settings.
• This model successfully addresses challenges of inadequate operating room space, time, and expense in Ghana.
• The approach improves patient outcomes and facilitates a quicker return to the workforce.