The value proposition of wide-awake local anesthesia no tourniquet surgery in the upper extremity

BACKGROUND: Wide-awake local anesthesia no tourniquet (WALANT) surgery offers a unique clinical and economic approach to delivering high-quality upper extremity care. PURPOSE: This article explores the evoluation, techniques, clinical efficancy, financial advantages, and future directions of WALANT as it establishes is growing role in value-based orthopedic care. In doing so, it outlines the value proposition of WALANT for patients, providers, and the hospital system. METHODS: The authors conducted a comprehensive PubMed search to identify studies evaluating the clinical and economic outcomes of WALANT surgery in upper extremity procedures. Eligible studies included prospective and retrospective research, as well as case studies and case series, comparing WALANT with traditional anesthesia. The studies examined focused on metrics such as functional outcomes, patient satisfaction, and cost savings for the patient and the hospital system. RESULTS: Current literature shows that hand and upper extremity surgery performed under WALANT yields similar functional outcomes and even demonstrates equal or higher patient satisfaction compared with traditional anesthesia. Regarding cost savings, WALANT's minimalist approach to procedures can lead to significant waste reduction and notable financial benefits for the patient, the provider, the hospital, and the wider healthcare system. CONCLUSIONS: WALANT surgery offers a compelling value proposition for the patient, the provider, and the healthcare system at large. Through efficient use of resources focused on minimizing waste and optimizing patient experience and outcomes, WALANT offers an opportunity for value-based surgical care. Further research into more sophisticated clinical uses and large-scale cost-savings analyses is necessary for WALANT procedures to be further validated and more broadly adopted. LEVEL OF EVIDENCE: Level V.