Expanding Access to Minor Hand Surgery Procedures in Underrepresented Patient Populations: Safety and Efficacy of a Minor Procedure Clinic in an Urban Safety-Net Hospital.

Abstract

Background: Minor hand surgeries are increasingly being performed in procedure rooms (PRs) rather than operating rooms (ORs). We aimed to determine the safety of PR-based hand surgeries at an urban safety-net hospital among an underserved patient population.

Methods: An institutional review board-approved retrospective review of PR-based hand surgeries from January 2022 to February 2024 was conducted. Patient demographics, comorbidities, surgery details, and complications were collected. Fisher exact test analyses were conducted with significant P value <0.05. Data analyses for race and insurance type were excluded because of lack of heterogeneity (>99% underrepresented racial groups, 100% public insurance).

Results: Of 202 surgical encounters, the most common surgeries were carpal tunnel release (n = 108, 46.4%), trigger finger release (n = 65, 27.9%), and mass excision (n = 37, 15.9%). Most patients (n = 184, 91.1%) had no postoperative complications. Among patients with postoperative complications, 90.5% were minor (i.e., pillar pain, catching/locking). The major postoperative complications included complex regional pain syndrome (n = 1, 0.5%) and deep surgical site infection (n = 1, 0.05%) requiring hospitalization for intravenous antibiotics and irrigation and débridement in the ORs. No other cases involved infection, hospitalization, or revision surgery. No intraoperative complications or death occurred. No significant difference was noted in postoperative complications based on language preference (P = 0.999).

Conclusion: PR-based minor hand surgeries demonstrate low complication rates at an urban safety-net hospital, suggesting safety among this specific underserved population. Additional research should explore multicenter cohorts to identify complication risk factors and aid in surgical decision making for vulnerable groups.