COST ANALYSIS BETWEEN WALANT (WIDE- AWAKE LOCAL ANESTHESIA NO TOURNIQUET) AND GA (GENERAL ANESTHESIA) IN METACARPAL PLATING - A STUDY IN MALAYSIA

The evolution of surgical practises has seen a remarkable shift from traditional general anaesthesia (GA) to the innovative approach of Wide-Awake Local Anaesthesia No Tourniquet (WALANT) for minor surgery indicated for a select group of patients. However, the cost savings of WALANT compared to GA is unknown in Malaysia. We hypothesise WALANT surgery is more cost efficient compared to GA in metacarpal plating.

All patients underwent open reduction and metacarpal plating at a public university hospital was included in this study. The data was collected from electronic medical records of metacarpal surgery from the hospital database between 2018 and 2024.  They were divided into two types of anesthesia- WALANT and GA. A cost analysis was conducted to compare the healthcare costs of metacarpal surgery with WALANT and GA. The total cost of care was determined using an activity-based costing approach from the perspective of the healthcare provider and applying the appropriate cost-to-charge ratio. The estimated costs were the average cost per patient per procedure using either WALANT or GA. The cost drivers were divided into three categories: hospitalisation, investigation and anesthesia charge.

A total of 48 patients were included; 25 (52.1%) underwent GA and 23 (47.9%) underwent WALANT. The mean cost for patients who underwent the procedure with GA was USD 206.92 with minimum and maximum costs of USD 103.69 and USD 392.88 respectively. The main cost driver was hospitalisation, which accounted for 65.5% of total cost, followed by investigations (18.3%) and GA procedures (16.3%). In contrast, for the patients who had WALANT, the average cost was USD 81.79  with a minimum of USD 28.8 and a maximum of USD 304.15. In the WALANT group, WALANT accounted for 58 % of the total cost for patients who did not require hospitalisation. For patients who required hospitalisation, the main cost driver was still hospitalisation, which accounted for 67.8% of total cost, followed by investigations (20.6 %) and WALANT procedures (11.6 %), nevertheless the costs were considerably lower than the costs in the GA group. The reduction in need for hospital admission improved operating theatre utilisation, which can effectively reduce medical costs. This preliminary analysis is essential and could help healthcare providers make informed decisions that balance patient outcomes with cost considerations and promote the use of WALANT for appropriate patient populations based on clinical indications.

WALANT is generally more cost-efficient than GA, as it eliminates the need for complex anesthesiology procedures and equipment. In addition, WALANT reduces the need for hospitalisations before and after the surgical procedure as well as the associated investigations. In a conclusion, due to the reduced recovery time and lower complexity of WALANT, it is often suitable for outpatient or ambulatory surgical settings, contributing to efficient healthcare delivery. This preliminary analysis is essential and could help healthcare providers make informed decisions that balance patient outcomes with cost considerations and promote the use of WALANT for appropriate patient populations based on clinical indications.

Keywords: WALANT, metacarpal plating, cost