A Comparison of Complication Rates in Flexor Tendon Repair Performed in Operating Rooms Versus Clinic-Based Procedure Rooms

Wide-awake local anesthesia no tourniquet (WALANT) surgery has demonstrated its value in hand surgery allowing surgeons to safely operate patients in different settings outside of a formal operating room (OR). Flexor tendon lacerations have historically been repaired in the controlled setting of an OR. Plastic surgeons at our university-affiliated center have increasingly been performing flexor repairs in clinic-based procedure rooms (PRs). This study set out to evaluate the safety and complication rates of primary flexor tendon repair performed in PRs compared to those performed in the OR. A unicentric retrospective study was conducted with patients who underwent primary flexor tendon repair between 2019 and 2023 in both clinic-based PRs and the OR. Primary outcomes included presence of tendon rupture and secondary outcomes included infection, adhesion, reintervention, and presence of any complication. Results are reported using odds ratios with 95% confidence intervals. One hundred seventy-four patients underwent flexor tendon repair. There was no association between rupture rate and surgical setting (OR 1.05 95% CI [0.30-3.78]; = .94). Surgeries performed in clinic-based PRs showed a reduction in the odds of observing at least one complication (OR = 0.49 [0.24-0.97]; = .041). A subanalysis of single digit cases showed a similar association between the rate of complications and surgical setting (OR = 0.39 [0.16-0.96]; = .039). This study confirms the safety of performing flexor repair in clinic-based PRs. Such settings also offer the advantage of reduced cost of surgery and minimized delay between diagnosis and surgery.