Autumn abstracts

Abstract

Aims: The demand for elective hand surgery has increased substantially over the last 10 years, with COVID-19 providing an added challenge of restrictions to face-to-face consultations. Our aim is to assess the viability, effectiveness and safety of an early discharge direct from the operating theatre, following common hand surgery procedures with the safety net of open access follow-up. Methods: All eligible patients undergoing simple open surgery under local anaesthesia, between February 2019 and December 2020, were offered early discharge. Informed consent was obtained in clinic, and they were counselled on rehabilitation immediately prior to surgery. Patients were provided with custom made open-access business cards with information on how to get in touch to request clinic follow up, simple post-operative instructions and hand exercises. A review was completed at a minimum of two months following surgery. Administrative support staff were briefed beforehand to minimise any delays in follow up requests, and either book patients who requested follow-up back into either a routine elective clinic or utilise ringfenced emergency elective clinic slots depending on their individual requirement. Results: 105 patients were included in this study, with an average age of 60 years. The average interval between surgery and review was 20 weeks. 89 patients had a successful early discharge with 16 patients requesting clinic follow-up. The average time to follow up in clinic was 35 weeks (range 4–84). There were zero complications and the most common reason for returning to clinic was actually for a new problem, unrelated to the surgery. Conclusions: Although virtual follow-up is now well established in both the fracture and elective clinic setting, early discharge is largely uncharted water. Our pilot demonstrates that early discharge and patient-led follow up for common elective hand surgical procedures under local anaesthesia is efficient, safe and viable.