Deep infection rate resulting in reoperation in minor hand surgery with wide-awake local anaesthesia no tourniquet (WALANT) under field sterility in an outpatient setting

Abstract

Background: The study aims to determine the incidence of surgical site infection (SSI) leading to reoperation following minor hand procedures performed outside the main operating room using field sterility.

Methods: The investigators retrospectively reviewed clinical records of 504 cases in 440 patients who underwent wide-awake local anaesthesia no tourniquet (WALANT) minor hand surgery in a field sterility setting over a four-year period between March 2019 and June 2023. The data was collected at a tertiary institution which serves members of the South African Military Service via a wide catchment area. SSI was defined according to the Centers for Disease Control and Prevention (CDC) occurring within four weeks postoperatively. Cases included were elective WALANT minor hand procedures in patients above 18 years.

Results: The deep SSI rate within four weeks postoperatively resulting in reoperation was 1% (95% confidence interval [CI] 0.01–0.02); infection rate for carpal tunnel release (CTR) was 2%, (95% CI 0.74–5.20). The majority of procedures performed were carpal tunnel and trigger finger eleases, with a female predominance at 57% and the average age of patients being 57 years (SD ± 13 years).

Conclusion: The study’s infection rate is comparable to international infection rates for similar surgeries performed using field sterility in an outpatient setting. Minor hand procedures performed under field sterility using WALANT have a low SSI rate with acceptable morbidity. This implies that WALANT under field sterility is a safe clinical practice.

Level of evidence: 4