COMPARISON OF CLINICAL OUTCOMES, PARENTAL ANXIETY, AND SURGEON SATISFACTION DURING OUTPATIENT CLINIC VERSUS OPERATING ROOM SETTING FOR ACHILLES TENOTOMY DURING PONSETI METHOD OF CLUBFOOT CORRECTION: A RANDOMIZED CONTROLLED TRIAL

Achilles tenotomy (AT) during idiopathic clubfoot correction can be performed either in an outpatient clinic (OPC) or operating room (OR) setting. However, there is no clear consensus regarding where to perform AT to produce better outcomes without major complications. To the best of our knowledge, no randomized control trial (RCT) was conducted to compare these two settings. Research question: Is AT done in OR under GA better than in OPC under LA? Through block randomization, 40 idiopathic clubfoot cases were allotted equally to the OPC and OR groups. After satisfactory correction of midfoot cavus, forefoot adduction, and hindfoot varus using Ponseti casting, percutaneous scalpel AT was performed for correcting ankle equinus either in OPC or OR. Parental anxiety through the STAI questionnaire, self-designed surgeon satisfaction questionnaire, and ankle dorsiflexion at the final follow-up were assessed. The mean age in the OPC and OR groups was 4.18 and 5.03 months, respectively. The mean number of casts was comparable between groups. The mean duration of the procedure was 19.80 and 53.50 minutes in the OPC and OR groups, respectively (p < 0.001). The mean infant-mother separation time was 59.75 minutes in the OR group. Intra-op bleeding was seen in three (15%) patients in the OPC group and one (5%) patient in the OR group; statistically insignificant (p = 0.605) between groups. Parental anxiety during the initial presentation at the clinic and pre-and post-operative periods were comparable in both groups. The mean total surgeon satisfaction score favors OR (25.10) as their preferred setting in comparison to OPC (23.05) (p = 0.009). The mean ankle dorsiflexion on one-year follow-up in the OPC and OR groups was 17.80° and 17.95°, respectively. AT done in OPC under LA is a safe, cost-effective procedure with less infant mother separation time and decreased overall procedural duration. Also, this setting has comparable clinical outcomes and similar parental anxiety during the pre-and post-procedural period to that done under GA in the OR.