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Avaliação da Redução de Custos com a Técnica Wide Awake Local Anesthesia No Tourniquet em Trauma do Punho e Mão
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Orientador(es)
Resumo(s)
Introdução
As lesões do punho e da mão são uma das principais causas de recorrência ao serviço de
urgência, exigindo muitas vezes tratamento cirúrgico. Habitualmente, estes
procedimentos são feitos em bloco operatório central, com anestesia geral ou
loco-regional, envolvendo frequentemente internamento hospitalar. Isto implica
recursos consideráveis e organização complexa. A técnica WALANT (Wide Awake Local
Anesthesia No Tourniquet) surgiu como uma alternativa promissora. Permite fazer
cirurgia com anestesia local, sem garrote e sem sedação, em regime ambulatório na
maioria dos casos. Apesar das vantagens já reconhecidas, ainda existem poucos estudos
que avaliem os seus custos em contexto hospitalar público, especialmente em situações
de trauma do punho e mão. Esta dissertação pretende preencher essa lacuna.
Metodologia
O estudo foi retrospetivo, observacional e quantitativo. Teve lugar na Unidade Local de
Saúde da Cova da Beira. Foram incluídos 99 doentes operados por trauma do punho e
mão entre janeiro de 2022 e dezembro de 2023. Desses, 49 foram tratados com
WALANT e 50 com técnicas convencionais. Foram analisadas variáveis clínicas,
operatórias e económicas. Para além disso, estimou-se uma poupança teórica com base
na conversão hipotética de casos legíveis para regime ambulatório com WALANT,
segundo critérios de complexidade e durabilidade cirúrgica. Os testes estatísticos
incluíram comparação de médias, ANCOVA e regressão quantílica.
Resultados
Os custos médios foram mais baixos no grupo WALANT em todos os parâmetros:
exames pré-operatórios anestésicos (0€ vs. 25,90€), equipa cirúrgica (88,69€ vs.
269,80€), internamento (58,58€ vs. 1.194,17€) e custo total (147,27€ vs. 1.489,87€). A
poupança real gerada com os 49 doentes operados com WALANT foi de 98.009,70€.
Além disso, 29 doentes tratados com técnicas convencionais poderiam, após análise
individual, ter sido operados com WALANT em ambulatório. A poupança adicional
estimada seria de 38.935,36€. No total, o hospital poderia ter economizado
136.945,06€. Não foram registradas complicações anestésicas em nenhum dos dois
grupos e a taxa de satisfação no grupo WALANT foi de 98,8%. Conclusão
Os dados obtidos neste estudo parecem revelar que a técnica WALANT constitui uma
alternativa segura, eficaz e claramente mais económica em comparação com as
abordagens anestésicas convencionais. A ausência de internamento, a dispensa de
exames pré-operatórios e a redução da equipa cirúrgica explicam grande parte da
diminuição dos custos observada. Para além disso, verificou-se um nível muito elevado
de satisfação reportado pelos utentes e não foram registadas complicações anestésicas,
o que reforça a eficiência e a fiabilidade desta abordagem. Estes resultados sugerem que
o modelo WALANT poderá desempenhar um papel estratégico na reorganização dos
circuitos hospitalares, promovendo maior eficiência, alinhamento com os princípios do
Value-Based Healthcare e do Lean Healthcare, e contribuindo ainda para a
sustentabilidade ambiental através da redução do desperdício hospitalar e da utilização
mais racional dos recursos. Embora se reconheça que a natureza retrospetiva do estudo
e a ausência de seguimento clínico prolongado constituem limitações, os resultados
alcançados reforçam a necessidade de desenvolver novas investigações em diferentes
contextos. Estudos prospetivos e multicêntricos serão fundamentais não apenas para
confirmar os achados aqui apresentados, mas sobretudo para aprofundar a
compreensão do impacto clínico, económico, organizacional e ambiental da técnica
WALANT no Serviço Nacional de Saúde.
Introduction Wrist and hand injuries are among the most frequent reasons for presentation to the emergency department, often requiring surgical intervention. Traditionally, these procedures are performed in a central operating theatre under general or regional anaesthesia and are frequently associated with hospital admission. This approach demands considerable resources and complex organisation. The WALANT technique (Wide Awake Local Anaesthesia No Tourniquet) has emerged as a promising alternative, enabling surgical procedures under local anaesthesia, without tourniquet or sedation, and predominantly in an outpatient setting. Despite its recognised advantages, there remains a lack of studies assessing its economic impact within public hospital settings, particularly in cases of wrist and hand trauma. This dissertation seeks to address this gap. Methodology This was a retrospective, observational and quantitative study conducted at the Local Health Unit of Cova da Beira. A total of 99 patients undergoing surgery for wrist and hand trauma between January 2022 and December 2023 were included. Of these, 49 were treated using the WALANT technique and 50 with conventional anaesthetic methods. Clinical, operative and economic variables were analysed. In addition, a theoretical cost-saving model was developed based on the hypothetical conversion of eligible cases to outpatient WALANT, according to predefined criteria of surgical complexity and duration. Statistical analysis included mean comparisons, ANCOVA and quantile regression. Results Average costs were consistently lower in the WALANT group across all parameters: preoperative anaesthetic investigations (€0 vs. €25.90), surgical team (€88.69 vs. €269.80), hospital admission (€58.58 vs. €1,194.17) and total cost (€147.27 vs. €1,489.87). The actual savings generated with the 49 WALANT cases amounted to €98,009.70. Furthermore, 29 patients treated with conventional methods could, upon individual review, have been managed with WALANT in an outpatient setting, with an additional estimated saving of €38,935.36. Overall, the hospital could have saved €136,945.06. No anaesthetic-related complications were recorded in either group, and patient satisfaction in the WALANT group reached 98.8%. Conclusion The findings of this study suggest that the WALANT technique represents a safe, effective and clearly more economical alternative when compared with conventional anaesthetic approaches. The absence of hospital admission, the elimination of preoperative investigations and the reduction in surgical team size account for much of the cost savings observed. Furthermore, patient satisfaction was reported at very high levels, and no anaesthetic-related complications were recorded, reinforcing the efficiency and reliability of this approach. These results indicate that the WALANT model may play a strategic role in the reorganisation of hospital pathways, fostering greater efficiency, alignment with the principles of Value-Based Healthcare and Lean Healthcare, and contributing to environmental sustainability through reduced hospital waste and more rational use of resources. While it is acknowledged that the retrospective nature of the study and the absence of long-term clinical follow-up constitute limitations, the results reinforce the need for further research in different contexts. Prospective and multicentre studies will be essential not only to validate the findings presented here, but also to deepen understanding of the clinical, economic, organisational and environmental impact of the WALANT technique within the National Health Service.
Introduction Wrist and hand injuries are among the most frequent reasons for presentation to the emergency department, often requiring surgical intervention. Traditionally, these procedures are performed in a central operating theatre under general or regional anaesthesia and are frequently associated with hospital admission. This approach demands considerable resources and complex organisation. The WALANT technique (Wide Awake Local Anaesthesia No Tourniquet) has emerged as a promising alternative, enabling surgical procedures under local anaesthesia, without tourniquet or sedation, and predominantly in an outpatient setting. Despite its recognised advantages, there remains a lack of studies assessing its economic impact within public hospital settings, particularly in cases of wrist and hand trauma. This dissertation seeks to address this gap. Methodology This was a retrospective, observational and quantitative study conducted at the Local Health Unit of Cova da Beira. A total of 99 patients undergoing surgery for wrist and hand trauma between January 2022 and December 2023 were included. Of these, 49 were treated using the WALANT technique and 50 with conventional anaesthetic methods. Clinical, operative and economic variables were analysed. In addition, a theoretical cost-saving model was developed based on the hypothetical conversion of eligible cases to outpatient WALANT, according to predefined criteria of surgical complexity and duration. Statistical analysis included mean comparisons, ANCOVA and quantile regression. Results Average costs were consistently lower in the WALANT group across all parameters: preoperative anaesthetic investigations (€0 vs. €25.90), surgical team (€88.69 vs. €269.80), hospital admission (€58.58 vs. €1,194.17) and total cost (€147.27 vs. €1,489.87). The actual savings generated with the 49 WALANT cases amounted to €98,009.70. Furthermore, 29 patients treated with conventional methods could, upon individual review, have been managed with WALANT in an outpatient setting, with an additional estimated saving of €38,935.36. Overall, the hospital could have saved €136,945.06. No anaesthetic-related complications were recorded in either group, and patient satisfaction in the WALANT group reached 98.8%. Conclusion The findings of this study suggest that the WALANT technique represents a safe, effective and clearly more economical alternative when compared with conventional anaesthetic approaches. The absence of hospital admission, the elimination of preoperative investigations and the reduction in surgical team size account for much of the cost savings observed. Furthermore, patient satisfaction was reported at very high levels, and no anaesthetic-related complications were recorded, reinforcing the efficiency and reliability of this approach. These results indicate that the WALANT model may play a strategic role in the reorganisation of hospital pathways, fostering greater efficiency, alignment with the principles of Value-Based Healthcare and Lean Healthcare, and contributing to environmental sustainability through reduced hospital waste and more rational use of resources. While it is acknowledged that the retrospective nature of the study and the absence of long-term clinical follow-up constitute limitations, the results reinforce the need for further research in different contexts. Prospective and multicentre studies will be essential not only to validate the findings presented here, but also to deepen understanding of the clinical, economic, organisational and environmental impact of the WALANT technique within the National Health Service.
Descrição
Palavras-chave
Anestesia Local Cuidados de Saúde Baseados em Valor Custos em Saúde Lesões da Mão Lesões do Punho