The Recovery Room Is Not Needed Following Hand Surgery With Local Anesthesia in the Outpatient Operating Room: A Prospective Study

BACKGROUND: The use of an outpatient operating room (OPOR) for hand surgery under local anesthesia only has increased due to efficiency and cost-effectiveness. Although prior research supports the safety of OPOR and outcomes equivalent to traditional operating room settings, the necessity of post-anesthesia care unit (PACU) monitoring for these patients remains uncertain. This study evaluated the safety of discharging patients directly home from the OPOR without PACU recovery. METHODS: A prospective study enrolled 102 patients who underwent carpal tunnel release and/or trigger finger surgery in the OPOR under local anesthesia only. Patients were discharged directly from the OPOR after a single set of postoperative vital signs. Outcomes included adverse events, emergency department (ED) visits, surgical reinterventions, and intraoperative and postoperative complications within 90 days. RESULTS: The mean patient age was 65.2 years (range, 25-94), and 60.8% were female. No intraoperative or postoperative complications, surgical reinterventions, or deaths occurred. Four patients (3.9%) presented to the ED within 90 days; 1 (0.9%) experienced an adverse event due to community-acquired pneumonia. No ED visits were related to a complication of the hand procedure. All patients were hemodynamically and respiratory stable at discharge. Forty-six patients (45.1%) had elevated blood pressure at discharge, 76.1% of whom had known hypertension. CONCLUSION: Bypassing PACU after OPOR hand surgery under local anesthesia only is safe. Direct discharge from the OPOR may reduce health care resource utilization, decrease costs associated with PACU recovery, and improve procedural efficiency without compromising patient safety.