Building on the pioneering work by Dr Don Lalonde, both Dr Asif Ilyas and Dr James Clarkson’s research has focused on advancing our understanding of wide awake surgery’s outcomes and safety, be it an office setting or in an ambulatory surgical center. The result of these efforts, as well as that of other surgeon researchers, is the establishment of the high efficacy, safety, and cost effectiveness of wide awake surgery in the US.

National guidelines for Wide Awake Office Based Surgery

Dr Clarkson published a detailed evidenced-based analysis of wide awake office based surgery and collated the evidence on its safety and efficacy, while also establishing guidelines for office based surgery.

Safety of Wide Awake Surgery

Many studies have focused on the safety of wide awake surgery, consistently confirming its safety – particularly with the use of epinephrine in the hand. Both Dr Lalonde and Dr Ilyas separately published their series of consecutive 3,110 and 4,054 patients, respectively, and confirmed no epinephrine-related complications

Infection Rates in Wide Awake Surgery

Examination of infection rates following surgery is a common and important area of analysis. Relative to wide awake surgery, separate studies by Drs Clarkson, Ilyas, and others has established that there is no increased infection rate when surgery is done in the office versus an operating and whether preoperative antibiotics are used or not.

Patient Perceptions & Outcomes in Wide Awake Surgery

Perhaps the most important evidence is how a patient feels and does after undergoing wide awake surgery. Study after study has confirmed both the strong patient perception and outcomes supporting the use of wide awake surgery.

Pain & Anxiety in Wide Awake Surgery

In recent years awareness around opioid-sparing pain management and mitigating anxiety for patients undergoing surgery has become forefront to optimize the patient experience and safety. Both Dr Clarkson and Dr Ilyas have carefully examined this issue and put forth strategies that improve upon the surgical experience relative to pain and anxiety highlighting how surgery can actually provide a better patient surgical experience.

Minimizing Waste with Wide Awake Surgery

An ongoing issue in surgery is the high amount of waste produced harming the environment. Dr Ilyas and others have looked at this problem and have established strategies to leverage wide awake surgery as a solution to tackling this issue plaguing our society.

Cost Savings with Wide Awake Surgery

Central to the establishment for wide awake surgery is the cost savings. The current paradigm for most surgeries performed in the US is payments made to the surgeon, anesthesiologist, and facility – with facility costs representing the largest and most variable portion of the financial burden. Wide wake surgery can result in tremendous cost savings to payors and patients by avoiding or mitigating the facility charges and eliminating the anesthesiologist charges.

Building on pioneering work by Dr Don Lalonde, Dr James Clarkson’s research focused on the evidence base needed to develop an practice in the US, publishing the only national guidelines for hand surgery. This was based on the huge WALANT literature with Lalonde’s work and his own publications which include: A randomized controlled trial and a 200 patient reported outcome study. Clarkson has written a book chapter on how to deliver hand surgery in the office environment and looked at the mechanisms that VR appears to work through to reduce patient anxiety. He has also published his comparative infection rates in the main operating room and the office, where he found reduced infection rates when his patients surgical care transitioned to the office environment.