A cost and efficacy analysis of performing arthroscopic excision of wrist ganglions under wide-awake anaesthesia versus general anaesthesia.

BACKGROUND: Arthroscopic excision has currently become popular for the treatment of wrist ganglions. The objective of this study was to evaluate the clinical outcomes and cost effectiveness of arthroscopic wrist ganglion excisions under Wide-Awake Local Anaesthesia No Tourniquet versus general anaesthesia. METHODS: We retrospectively reviewed patients who underwent arthroscopic ganglionectomy from April 2009 to October 2016 at our institute. They were separated into two groups according to anaesthesia techniques: general anaesthesia and Wide-Awake Local Anaesthesia No Tourniquet. We compared the clinical outcomes and cost-effectiveness of the two groups. RESULTS: Seventy-four patients were included. Both groups were matched with regard to the demographics and preoperative clinical assessments. We found no significant differences between groups in postoperative visual analog scale, modified Mayo wrist score, Disabilities of Arm, Shoulder and Hand score, recurrence, residual pain, or complications. Recurrence was found in five of 74 patients, one (4.3%) in the Wide-Awake Local Anaesthesia No Tourniquet group and four (7.8%) in the general anaesthesia group. One extensor tendon injury and four extensor tenosynovitis cases occurred in the general anaesthesia group. Regarding cost effectiveness, the mean operating time in the Wide-Awake Local Anaesthesia No Tourniquet and general anaesthesia groups were 88.7 ± 24.51 and 121.5 ± 25.75 min, respectively (p < 0.001). The average total costs of the Wide-Awake Local Anaesthesia No Tourniquet and general anaesthesia groups were €487.4 ± 89.15 and €878.7 ± 182.13, respectively (p < 0.001). CONCLUSIONS: For arthroscopic wrist ganglion resections, both anaesthesia techniques were effective and safe regarding recurrence rates, complications, and residual pain. The most important finding of this study was that arthroscopic ganglionectomy under Wide-Awake Local Anaesthesia No Tourniquet was superior to that under general anaesthesia for cost-effectiveness. LEVEL OF EVIDENCE: Level III, Retrospective comparative study.

Supplementary pedicle screw fixation in spinal fusion for degenerative spondylolisthesis in patients aged 65 and over: outcome after a minimum of 2 years follow-up in 82 patients.

BACKGROUND: There have been few reports assessing the outcome of laminectomy and posterolateral fusion with pedicle screw fixation for degenerative spondylolisthesis in the elderly. In a retrospective study, we assessed the clinical and radiographic outcome of this treatment in degenerative spondylolisthesis patients aged >or= 65 years. PATIENTS AND METHODS: 82 patients (61 females) aged >or= 65 years underwent laminectomy and posterolateral fusion with pedicle screw fixation for degenerative spondylolisthesis. The median age at surgery was 69 (65-79) years. The mean bone mineral density before surgery was -1.9 (-1.0 to -2.5). After an average of 3 (2-11) years follow-up, patients were classified as "satisfied" or "dissatisfied" according to self-reported outcomes and also as "solid fusion" or "no solid fusion" according to the radiographic findings. RESULTS: At final follow-up, the average Oswestry disability index (ODI) score was lower than the preoperative score (30 vs. 56) (p = 0.03). Four-fifths of the patients stated that they were satisfied with the outcome. Almost three-quarters of the patients achieved definite fusion. Although patients with advanced age or reduced bone mineral density were not more likely to have dissatisfactory results (p = 0.8 and p = 0.6, respectively) they were more likely to have radiographic results showing "absence of solid fusion" (p = 0.005 and p < 0.001, respectively). INTERPRETATION: We believe that supplementary pedicle screw fixation after laminectomy and posterolateral fusion will be an effective choice for the ever-increasing number of patients aged >or= 65 years who will be prone to develop degenerative spondylolisthesis.