Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2022; 13(7): 644-651
Published online Jul 18, 2022. doi: 10.5312/wjo.v13.i7.644
Association between tourniquet use and intraoperative blood loss during below-knee amputation
Alden E Wyland, Erik Woelber, Liam H Wong, Jordan Arakawa, Zachary M Working, James Meeker
Alden E Wyland, Liam H Wong, School of Medicine, Oregon Health and Sciences University, Portland, OR 97239, United States
Erik Woelber, Jordan Arakawa, Zachary M Working, James Meeker, Department of Orthopaedics and Rehabilitation, Oregon Health and Sciences University, Portland, OR 97239, United States
Author contributions: Woelber E, Meeker J and Working Z contributed the study conception and design; Wyland AE, Wong LH and Arakawa J contributed the generation, collection of the data; Wyland AE and Woelber E contributed the assembly, analysis and/or interpretation of the data; Wyland A, Woelber E, Meeker J and Working Z contributed to drafting and revising the manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board (STUDY00020406).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/Licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.
Data sharing statement: Data and study materials are available upon reasonable request from the corresponding author at meekerj@ohsu.edu. Consent was not obtained, but the data are anonymous and the risk of identification is low.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: James Meeker, MD, Assistant Professor, Department of Orthopaedics and Rehabilitation, Oregon Health and Sciences University, 3181 SW Sam Jackson Road, Portland, OR 97239, United States. meekerj@ohsu.edu
Received: February 28, 2022
Peer-review started: February 28, 2022
First decision: April 13, 2022
Revised: May 27, 2022
Accepted: July 6, 2022
Article in press: July 6, 2022
Published online: July 18, 2022
Processing time: 139 Days and 5.6 Hours
Abstract
BACKGROUND

Despite over 150000 amputations of lower limbs annually, there remains a wide variation in tourniquet practice patterns and no consensus on their necessity, especially among orthopedic patient populations. The purpose of this study was to determine whether tourniquet use in orthopedic patients undergoing below knee amputation (BKA) was associated with a difference in calculated blood loss relative to no tourniquet use.

AIM

To determine if tourniquet use in orthopedic patients undergoing BKA was associated with a difference in calculated blood loss relative to no tourniquet use.

METHODS

We performed a retrospective review of consecutive patients undergoing BKA by orthopedic surgeons at a tertiary care hospital from 2008 through 2018. Blood loss was calculated using a combination of the Nadler equation for preoperative blood volume and a novel formula utilizing preoperative and postoperative hemoglobin levels and transfusions. Univariate and forwards step-wise multivariate linear regressions were performed to determine the association between tourniquet use and blood loss. A Wilcoxon was used to determine the univariate relationship between tourniquet use and blood loss for in the restricted subgroups of patients who underwent BKA for trauma, tumor, and infection.

RESULTS

Of 97 eligible patients identified, 67 underwent surgery with a tourniquet and 30 did not. In multivariate regression, tourniquet use was associated with a 488 mL decrease in calculated blood loss (CI 119-857, P = 0.01). In subgroup analysis, no individual group showed a statistically significant decrease in blood loss with tourniquet use. There was no significant association between tourniquet use and either postoperative transfusions or reoperation at one year.

CONCLUSION

We found that tourniquet use during BKA is associated with decreased calculated intraoperative blood loss. We recommend that surgeons performing this procedure use a tourniquet to minimize blood loss.

Keywords: Amputation; Tourniquet; Blood loss; Hemostasis

Core Tip: We retrospectively evaluated 138 patients who underwent a below knee amputation by an orthopedic surgeon and compared the calculated intraoperative blood loss between patients who received or did not receive a tourniquet. We found that patients who did receive a tourniquet had significantly lower blood loss than those who did not.