In hand surgery, doctors are attempting to increase patient satisfaction by performing a number of small technique in the doctor’s office. This study compares in-office hand procedures to those performed at ambulatory surgery centers (ASCs) in terms of patient satisfaction, out-of-pocket expenses, pre- and postoperative discomfort, convenience, and comfort.
Patients who underwent minor hand surgeries in Florida, USA, were given a 10-question survey that included a 10-point Likert scale of agreement and numerical questions. Bony reconstruction, percutaneous pinning, open internal fixation, closed fracture reduction, mass removal, endoscopic carpal tunnel release, Dupuytren’s release/tendon repair, and trigger finger release are among the surgical techniques covered. Through a chart review, procedures and patient characteristics were evaluated. Statistical relationships were determined using the independent samples t-test, with significance set at p 0.05.
Patients gave resounding yes answers to questions 1-3 and 6–8, demonstrating a high level of comfort, convenience, and general satisfaction with both in-office and ASC procedures. Positive metrics averaged 9.64 0.14 in the office context and 9.62 0.16 in the ASC setting as measured by questions 1-3 and 6–8. The average scores for questions 4 and 5 in the office environment were 2.74 0.29 and 2.84 4.12 respectively, indicating a slight disagreement with the statement that the procedure or recovery period was uncomfortable. Patients who underwent surgery in an office setting reported missing 0.91 to 2.80 days of work, while those who underwent surgery in an ASC reported missing 12.43 to 22.51 days (p = 0.0039). Depending on insurance coverage, respondents reported out-of-pocket expenses ranging from $348 to $943 in the office setting to $574 to $1262 in the ASC environment (p = 0.3019).
Patient satisfaction scores were comparable, despite the fact that costs and time away from work varied between the two groups as a result of the various procedures in each environment. These findings show that patients treated in-office and in an ASC had equal levels of approval with their hand surgical care, even though patient satisfaction relies on the operating physician.
An essential measure of clinical care quality is patient satisfaction. It has various consequences for patients and healthcare professionals and is favorably correlated with greater care quality. Benefits of patient happiness include increased patient retention, higher profitability, greater staff and physician satisfaction, and a decline in malpractice claims. The level of care provided may also be reflected in patient satisfaction [1-6].
By providing patients with in-office procedures for minor surgeries including carpal tunnel release, trigger finger release, needle aponeurotomy, fracture reduction, and mass removal, doctors in the field of hand surgery are attempting to increase patient satisfaction. In-office procedures are carried out using the Wide-Awake Local Anesthesia No Tourniquet (WALANT) method of local anesthesia and hemostasis in procedural rooms (PRs) designed for simple procedures [7,8]. By providing secure, effective care delivery inside the doctor’s office, this expanding trend in hand surgery might raise patient satisfaction. Shorter wait periods for surgery scheduling, more patient involvement during WALANT treatments, lower medical expenses, and fewer follow-up visits are a few possible advantages of in-office PR procedures [8–17]. 94% of patients who underwent in-office carpal tunnel release and A1 pulley release operations as part of a 2017 study by Rhee et al. indicated that they would select WALANT again.
The advantages of in-office operations are well supported by research, but additional information is needed to compare in-office procedures to those performed in ambulatory surgery centers (ASCs) or hospitals to determine patient satisfaction. In order to ascertain if the procedural setting affects patient satisfaction, this study aims to do a unit analysis of patients who underwent a number of common hand procedures in the office and ASC settings. In addition to assessing how procedural settings affect patient satisfaction, we also aim to determine how satisfied patients are with their care. This covers general satisfaction, ease of scheduling, procedural comfort, pre- and postoperative pain, time missed at work, and out-of-pocket expenses. Hand surgeons will learn how to best serve their patients by comparing patient satisfaction across multiple settings, which will result in more patient-centered care.
Materials & Procedures
In Florida, the United States, between December 2020 and December 2021, a retrospective review of patients who received minor hand surgeries in the office PR or ASC was conducted. One orthopedic hand surgeon provided care for each patient. Excision of the hook of hamate, revision of a digital amputation, percutaneous pinning, open reduction internal fixation, closed fracture reduction, mass removal, endoscopic carpal tunnel release, Dupuytren’s release/tendon repair, and trigger finger release are among the surgical techniques covered. According to the operating surgeon’s regular procedure, post-operative follow-up appointments were made for each patient. One of the aforementioned operations in the office PR or ASC, completion of the postoperative phone survey, and attendance at a postoperative follow-up appointment were requirements for inclusion. There were no requirements for exclusion.
A search revealed 437 individuals who underwent minor hand surgeries, including 296 patients who were treated in an ASC and 141 patients who were treated in an office procedure room. A 10-question survey with a 10-point Likert scale of agreement and numerical questions was attempted to be given to all patients. Figure 1 displays the participant survey that was given out.
Figure 1: Survey of patient satisfaction
Aspects of the surgery experience were examined through questions, including comfort, pain, general satisfaction, time away from work, and out-of-pocket expenses. Concerning patient convenience and comfort in the operating room were questions 1-3 and 7. Regarding patient pain during and after surgery, see questions 4 and 5. Patient satisfaction overall was the subject of questions 6 and 8. Question 9 inquired about the amount of time missed from work following the procedure, while Question 10 inquired about the patient’s out-of-pocket expenses.
Through electronic health records (EHRs), patient demographic data, surgical history, and contact details were gathered. All surveys were conducted via telephone interview by qualified researchers. At the start of the phone conversation, each participant was given information about the study’s goals and asked for their informed consent to participate. Patients who did not respond to the initial contact were called again the next day. The evaluation of continuous variables obtained through chart inspection and survey responses was done using an independent samples t-test. The cutoff for significance was p 0.05.
Phone calls were made to 151 patients who had received care in an office setting (58) or an ASC environment (93) and who agreed to participate in the survey (35% response rate). The average age of the 59 male and 92 female respondents was 63.60 15.47 years, with no appreciable differences in age or gender between the in-office and ASC groups. In the ASC setting, more intrusive procedures such endoscopic carpal tunnel release and fracture reduction were more commonly carried out (Table 1).
Office procedures relating to ASC
Internal Fixation 7 0 Percutaneous Pinning 0 0 Open Reduction 7 0 Bony ReconstructionClosed Fracture Reduction: 18 0Dupuytren’s release or tendon repair 35 1 Mass removal 0 2 Endoscopic carpal tunnel release 9 10 Mass removal4 12 Release Finger Trigger19 33
Multiple Operations Performed During Surgery 6 0
Table 1 lists the procedures performed in the ASC and office procedure rooms.
Table 2 and Table 3 show the survey results for in-office and ASC patients, respectively. Responses to survey questions 1 through 8 are rated from 1 to 10, with a score of 10 representing the highest level of agreement. Responses to the survey show that both in-office and ASC patients strongly agree with the positive metrics in questions 1-3 and 6–8. A slight disagreement with the statement that the procedure or recovery period were “painful” in the office or ASC setting. All but six patients (4.0%) in both groups gave replies of seven or above to question 6, suggesting a moderate to strong intention to have future hand procedures in the same location if one was available.
First of all, convenienceExpectations were met in question 2 Question 3: ConvenienceQuestion 4: Surgery hurt.Five: The healing process was painfulShould I Pick This Setting Again?7: Appropriate SchedulingAverage Patient Satisfaction Question 89.69 9.38 9.79 2.53 2.95 9.62 9.64 9.71
Typical Deviation1.03 1.47 0.81 2.27 2.37 1.41 1.00 1.08 Count58 58 58 58 58 58 58 58
Table 2: In-office patient survey resultsFirst of all, convenienceExpectations were met in question 2Comfortable Question 4: The procedure was painfulFive: The healing process was painfulShould I Pick This Setting Again?7: Appropriate SchedulingAverage Patient Satisfaction Question 89.47 9.42 9.81 2.00 3.69 9.57 9.81 9.66
Typical Deviation1.46 1.65 0.80 2.03 2.80 1.62 1.01 1.57 Count 93 93 93 93 93 93 93 93
Table 3: ASC patient survey results
Ambulatory Surgery Center, or ASC
At the time of surgery, 39.6% of participants were retired, with no difference between groups (p = 0.7225). Patients treated in the ASC reported taking 12.43 22.51 days off work, compared to 0.91 2.80 days reported by those treated in the office among employed respondents (p = 0.0039). In addition, respondents reported out-of-pocket expenses ranging from $348 to $943 on average in the office setting and from $574 to $1,262 on average in the ASC setting, with significant variations based on insurance or Medicare coverage (p = 0.3019). There were no appreciable variations in survey responses or patient characteristics across the two surgical sites, with the exception of time missed from work for recovery.
In-office hand surgery has become more commonplace in recent years . A hybrid style of treatment is increasingly popular, wherein simple procedures are provided more frequently in the office environment and more invasive procedures are only performed in the ASC or hospital setting. By doing more minor procedures in the office environment, this paradigm enables a more practical method of healthcare delivery and enhances the availability of ASC and hospital operating rooms. Offerings currently depend mainly on how comfortable a physician is performing some procedures in an office setting and how much support each surgeon feels is necessary for each surgery . This assessment is based on the patient’s features, the difficulty of the procedure, and whether general anesthesia or regional nerve blocks are required.
We still don’t know the exact criteria that would make an operation suitable for a certain patient in an office setting. However, our survey findings imply that many working doctors might benefit from more research on the security and patient satisfaction of in-office surgery . Operating in the office has numerous advantages for the clinician and patient, even though the higher degree of assistance provided in the ASC is necessary to properly undertake more invasive surgeries [3,4,12,15,16]. First off, operating in an office setting is more convenient for surgeons since it allows them to treat more patients without having to leave the building and uses less unneeded anesthetic [7,9]. Because of this, doctors may see patients more quickly and with lower wait periods . As it can reduce demand for ASC and hospital operating rooms without sacrificing patient safety or satisfaction, the office environment is especially desirable in areas with a dearth of operating room availability.
Less invasive procedures are more frequently carried out in an office PR, as demonstrated by the disparities in recovery times between patients treated in the office (0.91 2.80 days off work) and ASC (12.43 22.51 days off work) (Table 1). Many patients benefit from having these less invasive hand procedures performed in the office since they need less supported resources, such as general anesthesia, regional nerve blocks, and support personnel. Local anesthetic, antiseptic skin preparation, common surgical equipment with a sterile area, and an assistant can all be used for in-office procedures. For procedures like trigger finger releases, which more frequently require follow-up surgeries to treat disease recurrence, the easier accessibility of in-office surgeries is especially advantageous.
The difference in patient out-of-pocket expenses for surgery between the two settings ($348 $943 in-office vs. $574 $1262 in the ASC setting) is statistically negligible. This disparity needs more research, taking into account insurance coverage and procedures performed, and may be caused by a type II error. The ratings of respondents did not significantly differ between the two surgical settings despite the variations in the sorts of surgeries carried out in each environment. Both in-office and ASC procedures scored highly on convenience, comfort, quick scheduling, general satisfaction, and desire to undergo a procedure in the same location again (Questions 1-3 and 6-8). In addition, negative metrics for operative and post-surgical pain (Questions 5 and 6) showed no discernible difference between the two settings, with replies indicating a mild level of pain experienced.
With the exception of a longer period of time missed from work following procedures in an ASC, survey respondents generally gave positive evaluations for both in-office and ASC surgeries. In all settings, patients reported little to no discomfort during and after surgery (Questions 4 and 5), great comfort and convenience (Questions 1-3, 7, and 9), and great pleasure (Questions 6 and 8). Patient satisfaction measures were comparable between the two groups, despite the fact that out-of-pocket expenses and time missed from work varied between the two groups due to the various operations performed in each environment. These findings show that patients’ happiness with their hand surgical care received during in-office and ASC procedures is comparable, even though the operating physician has an impact on patient satisfaction.
Comparing the provider costs for in-office procedures with ASC procedures would provide an opportunity for additional research in this area. According to a recent study, carpal tunnel procedures in operating rooms are much more expensive than those in clinic PRs . Contrasting the prices of a wider range of operations in the two scenarios. The sample size and the way that patients were surveyed over the phone are limitations of this study.
Our findings show that most people would choose to have any additional minor hand surgeries performed in an office environment again if given the choice, supporting the use of in-office procedures for those procedures. Future study may examine patient perceptions of hand surgeries in various surgical settings for certain operations and compare the costs of surgeries dependent on the surgical setting. Patients who underwent in-office PRs overwhelmingly supported having the treatment done there, showing the potential advantages of operating in the office for specific patients and procedures for both patients and clinicians.