Lean and Green Hand Surgery in the Office: Does It Work?

Purpose: The safety of wide-awake (WA) anesthesia has been documented in multiple studies. An advantage of WA is the ability to do Lean and Green hand surgery. Lean and Green surgery can be performed safely with considerable cost savings, reduced waste, and high patient satisfaction. This study reviews one surgeon's experience combining both WA and Lean and Green surgery principles in an office-based procedure room. This study evaluates patient satisfaction, complications, and cost savings in a group of patients treated with WA anesthesia and a Lean and Green technique. Methods: A retrospective chart review of a single surgeon's office-based cases was performed. In total, 437 surgical cases performed over a 12-month period were reviewed. Institutional review board approval was not needed for the chart review. Study items included infections, secondary procedures, patient satisfaction, and cost and trash savings seen with custom (Lean and Green) surgical packs. Results: The overall infection rate was 5% (all superficial infections). All infections were treated with oral antibiotics. There were no deep infections and no secondary procedures. The cost and waste savings using the Lean and Green surgical packs were significant. Using the custom surgical packs, there was a cost savings of $4,650 for the year. The waste savings were significant: 2,211 pounds (lbs) or 1.1 tons. Patient satisfaction was high. In total, 99% rated their surgical experience the same or better than a dental visit. In addition, 99% would recommend to a friend or family member, and 99% would do the office-based surgery again. Conclusions: Office-based WA hand surgery using Lean and Green principles is safe and cost-effective with high patient satisfaction. Clinical relevance: Office-based hand surgery combined with WA surgical principles and custom Lean and Green surgical packs was safe, cost-effective, and environmentally sound with high patient satisfaction.