American Association of Plastic Surgeons

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15350 Consecutive Upper Extremity Cases Without Anesthesiologists: Do Hand Surgeons In Ambulatory Surgery Centers (asc) Still Need Them?
Daniel Calva-Cerqueira, MD, Raul A. Cortes, MD, Nicholas Fort McLaury, MD, Patrick Harbor, MD, roger K. khouri, MD;
Miami Hand Center, Key Biscayne, FL, USA

Anesthesiologists require preoperative workups, medical clearances, intravenous lines, narcotics, additional drugs, and time in recovery. Besides the potential complications of intravenous anesthesia, this leads to elevated costs, delay in care, and longer times in facility. Armed with modern ultrasonic devices and knowledge of the anatomy, our surgeons became deft at Ultrasound-Guided-Regional-Blocks (UGRB). We reviewed our ASC experience with no preoperative workup, and expedient care with by the surgeon without anesthesiologists in the center.
We retrospectively reviewed all upper extremity cases performed over a 7-year period in our outpatient surgery center without anesthesiologists. Operative data, complications, demographics, clinical characteristics, time in facility, complications, and functional outcomes were evaluated. RESULTS:
Over 7 years we performed 15,350 upper extremity operations. Blocks were: 3,283supraclavicular, 7,438wrist/forearm, and rest digital. Average block time took 3.2min (1.5-7.5min). Overall check-in to check-out facility time: 24.5min (13-83min) and for Distal Radius Fractures (DRF): 68minutes. Average tourniquet time: 12.5min (3-100 min). Common cases were ECTR:5,119, forearm and DRF:2,254. From clinic-to-surgery average time was 3.4days. Patients were 11,753ASA1, 3,359ASA2, and 238ASA3. No preoperative work up, no labs, no clearance, no intravenous line, no recovery room time. There was one transient unilateral phrenic nerve palsy, 72 partial nerve block requiring supplementation, 3 CRPS, high patient satisfaction, no anesthesia complications, and expedited care.
Our significant clinical experience shows that in outpatient ASCs, surgeons without anesthesiologists can, safely and effectively deliver UGRB. This arrangement saves money, time, resources, and expedites patient care without compromising quality while probably increasing patient safety.
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