The Aberdeen Experience of Lean and Green Ward-Based Carpal Tunnel Surgery: A Safety and Efficiency Audit

Carpal Tunnel Decompression (CTD) is the most performed hand surgery in the UK. Increasing demand, limited theatre access, and NHS sustainability goals have led to the adoption of ward- based CTDs. This audit aimed to evaluate the safety, efficiency, and environmental impact of CTDs performed in theatre versus the ward (Department of Scheduled Admissions, DOSA) in NHS Grampian. 279 patients underwent CTD under local anaesthetic between August 2023 and April 2025 (150 in theatre, 129 on DOSA). Infection rates were analysed across all patients. Additional evaluations included operative time (n=38 DOSA, n=41 theatre), staffing (n=91), adherence to BSSH out-of-theatre guidelines (n=40), patient questionnaires (n=27), and waste output (n=4 cases). Infection rates were low and not significantly different between cohorts: 2% (3/150) in theatre vs 1.6% (2/129) in DOSA (p=0.95). All infections were either superficial or suture abscesses. Patients in DOSA had shorter hospital stays (mean 2.2 vs 4.4 hours), lower staff numbers (mean 3 vs 9 per procedure), and equivalent operative duration (13.6 vs 15.3 minutes). Questionnaire feedback (n=16 DOSA, n=11 theatre) showed greater patient satisfaction with lower wait times in DOSA. Waste produced per case was lower in DOSA (2.1kg vs 3kg). Full compliance with BSSH safety standards was achieved on ward-based lists. In conclusion, ward-based CTDs are safe, efficient, and align with environmental sustainability targets. Comparable infection outcomes, shorter stays, reduced staffing needs, and positive patient feedback support expanding ward-based CTD as a viable alternative to theatre-based CTD.