Comparing Complication Rates in Procedures Performed in the Operating Room Versus In-Office: A Cohort Study

In-office Wide Awake Local Anesthesia No Torniquet (WALANT) is an increasingly popular setting for minor hand procedures. The purpose of this study is to compare complication profiles of common procedures performed in the operating room (OR) versus in the office.

We performed a retrospective cohort study of patients who underwent trigger finger release, hand/wrist mass excision, open carpal tunnel release, first dorsal compartment release, extensor tendon repair, or needle aponeurotomy between January 1, 2018, and December 31, 2022, at a single private practice location. Patients were stratified by the location of their procedure: in-office versus in the OR. Data collected included standard demographic information, procedure information, and complication profile. Continuous variables were analyzed with means/standard deviations and compared using a Student t test. Categorical variables were compared using a χ² test. P values less than .05 were considered statistically significant.

We identified 2182 patients meeting the inclusion criteria, 1228 in the in-office WALANT group and 954 in the OR group. Patients in the in-office WALANT group were generally older with more medical comorbidities than patients in the OR group. There were no significant differences in complication rates between the groups. However, smokers or patients with autoimmune diseases had a higher complication rate when their procedure was performed in the office as opposed to the OR.

This study provides valuable information for counseling patients as to the setting of their procedure. While in-office WALANT provides a safe and convenient setting for minor procedures in most patients, others may be at increased risk of complication.