Quantitative Analysis of Anesthesia Utilization in Ambulatory Hand Surgery.

Area of Science:

• Orthopedic surgery
• Anesthesiology
• Health services research

Background:

• A lack of consensus exists regarding the optimal anesthetic modality for surgical procedures, despite growing evidence for local anesthetic benefits.
• General and regional anesthesia remain preferred options for specific patient and procedural factors, including anxiety, complexity, and pain tolerance.

Purpose of the Study:

• To analyze trends in anesthetic utilization for common outpatient hand procedures between 2010 and 2019.
• To investigate the hypothesis that local anesthetic (including Wide-Awake Local Anesthesia with no Tourniquet - WALANT) use increased while general and regional anesthesia use decreased during this period.

Main Methods:

• A cross-sectional analysis of the Texas Healthcare Information Collection Outpatient Database from 2010-2019.
• Inclusion of ambulatory procedures such as carpal tunnel release, trigger finger release, and hand mass excision.
• Categorization of anesthetic options into regional anesthesia (RA), local or WALANT anesthesia (LA), and general anesthesia (GA).

Main Results:

• Local anesthetic (LA) was utilized in 98.14% of the 340,117 procedures analyzed.
• No significant individual growth was observed for LA (-0.12%), RA (0.09%), or GA (0.03%) over the study period.
• A significant proportional shift in anesthetic use was observed when comparing all modalities (p<0.001), with commercial/private insurance being the most common payer.

Conclusions:

• Local anesthetic (LA) remained the predominant anesthetic modality for outpatient hand procedures.
• Despite LA's prevalence, a notable shift occurred towards increased use of regional anesthesia (RA) and general anesthesia (GA) over time.
• Medicaid disproportionately covered procedures performed under GA, and RA use was higher in mid-sized population centers.