Patient Selection for Wide-Awake Local Anesthesia No Tourniquet Surgery: The Role of PROMIS Anxiety and Depression Scores—A Pilot Study

Background: Wide-awake local anesthesia with no tourniquet (WALANT) surgery is increasingly used for hand procedures. Yet patient selection remains largely based on surgeon judgment, and evidence-based criteria for identifying patients most likely to tolerate and prefer WALANT are not well defined. Psychological factors such as anxiety and depression may influence the patient’s experience during awake surgery. Purpose: We sought to better define the factors that may influence patient acceptance of WALANT surgery and inform patient selection. The primary aim was to evaluate whether postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and depression scores are associated with willingness to undergo repeat WALANT surgery. A secondary aim was to compare anxiety and depression scores of patients who had undergone WALANT to population norms. Methods: We conducted a retrospective chart review of 228 patients who underwent WALANT surgery at a single institution, of whom 83 consented to complete a postoperative telephone survey. The survey of the 83 patients who opted to participate included PROMIS Emotional Distress-Anxiety Short Form 7a and the PROMIS Emotional Distress-Depression Short Form 8b and questions on the patient’s preference for repeat WALANT. The chart review of the 228 patients collected data on demographics, comorbidities, psychiatric history, and postoperative complications. To ensure that the patients who opted to participate in the survey did not differ significantly from all patients identified, statistical analyses were performed, including t -tests and χ 2 or Fisher’s exact tests. Results: Of the 83 patients surveyed, 79 (95.2%) said they would undergo WALANT again. The most common reason for saying they would not do so was intraoperative discomfort (50%). Mean PROMIS anxiety (44.59) and depression (43.72) scores were lower than the general population (mean of 50). Demographic factors and comorbidities did not differ significantly between WALANT patients who completed the survey and those who did not. Conclusions: In this pilot study, most survey respondents said they would be willing to undergo repeat WALANT surgery. PROMIS anxiety and depression scores were not associated with willingness to undergo WALANT in those surveyed. Given the small survey cohort, these findings should be considered preliminary, and larger studies are needed to better define the relationship between anxiety and depression and patient acceptance of WALANT. Among patients who were not willing to undergo repeat WALANT surgery, intraoperative discomfort was the most cited reason, suggesting that optimizing patient comfort during WALANT procedures may be more important for future acceptance than baseline anxiety or depression. Level of Evidence: Level IV: retrospective chart review and survey.