WALANT Versus Sedation for Hand Trauma: A Comparative Cost Analysis in a Portuguese Public Hospital.

Background: Wide-awake local anesthesia no tourniquet (WALANT) has been increasingly adopted in elective hand surgery; however, its economic impact in acute hand trauma remains insufficiently documented within the Portuguese public healthcare system. This study compares hospital costs associated with WALANT-based and conventional anesthesia-based care pathways in the surgical treatment of acute hand and wrist trauma. Methods: A retrospective observational study was conducted, including all adults undergoing surgery for acute hand or wrist trauma during a 2-year period at a Portuguese public hospital. Patients were classified into the WALANT or non-WALANT groups according to routine practice. Cost comparisons were adjusted for age and diagnostic group. A restricted sensitivity analysis was performed among patients not treated with WALANT who were retrospectively considered eligible for WALANT. Results: Ninety-nine patients were included, with 49 treated with WALANT and 50 with conventional anesthesia. Adjusted analyses demonstrated lower costs in the WALANT group. Cost reductions were primarily driven by the avoidance of hospital admission, with additional contributions from reduced surgical team size and the absence of routine preoperative investigations. In the sensitivity analysis, lower total cost, lower direct cost excluding hospitalization, and shorter length of stay remained significant. The hypothetical model suggested additional potential savings. Conclusions: A WALANT-based care pathway was associated with lower hospital costs in the surgical management of acute hand and wrist trauma, suggesting that it may represent an efficient strategy for care pathway reorganization in the Portuguese public healthcare system.