SORA

Advancing, promoting and sharing knowledge of health through excellence in teaching, clinical practice and research into the prevention and treatment of illness

The risks associated with tourniquet use in lower limb trauma surgery: a systematic review and meta-analysis.

Farhan-Alanie, MM; Dhaif, F; Trompeter, A; Underwood, M; Yeung, J; Parsons, N; Metcalfe, A; Wall, PDH (2021) The risks associated with tourniquet use in lower limb trauma surgery: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol, 31 (5). pp. 967-979. ISSN 1633-8065 https://doi.org/10.1007/s00590-021-02957-7
SGUL Authors: Trompeter, Alex Joel

[img]
Preview
PDF Published Version
Available under License Creative Commons Attribution.

Download (1MB) | Preview
[img] Microsoft Word (.docx) (Supplementary file 1) Published Version
Available under License Creative Commons Attribution.

Download (14kB)
[img] Microsoft Word (.docx) (Supplementary file 2) Published Version
Available under License Creative Commons Attribution.

Download (30kB)

Abstract

PURPOSE: Tourniquet use in lower limb fracture surgery may reduce intra-operative bleeding, improve surgical field of view and reduce length of procedure. However, tourniquets may result in pain and the production of harmful metabolites cause complications or affect functional outcomes. This systematic review aimed to compare outcomes following lower limb fracture surgery performed with or without tourniquet. METHODS: We searched databases for RCTs comparing lower limb fracture surgery performed with versus without tourniquet reporting on outcomes pain, physical function, health-related quality of life, complications, cognitive function, blood loss, length of stay, length of procedure, swelling, time to union, surgical field of view, volume of anaesthetic agent, biochemical markers of inflammation and injury, and electrolyte and acid-base balance. Random-effects meta-analysis was performed. PROSPERO ID CRD42020209310. RESULTS: Six RCTs enabled inclusion of 552 procedures. Pooled analysis demonstrated that tourniquet use reduced length of procedure by 6 minutes (95% CI -10.12 to -1.87; p < 0.010). We were unable to exclude increased harms from tourniquet use. Pooled analysis showed post-operative pain score was higher in tourniquet group by 12.88 on 100-point scale (95% CI -1.25-27.02; p = 0.070). Risk differences for wound infection, deep venous thrombosis and re-operation were 0.06 (95% CI -0.00-0.12; p = 0.070), 0.05 (95% CI -0.02-0.11; p = 0.150) and 0.03 (95% CI -0.03-0.09; p = 0.340). CONCLUSION: Tourniquet use was associated with a reduced length of procedure. It is possible that tourniquets also increase incidence of important complications, but the data are too sparse to draw firm conclusions. Methodological weaknesses of the included RCTs prevent any solid conclusions being drawn for outcomes investigated. Further studies are required to address these limitations.

Item Type: Article
Additional Information: © Crown 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Keywords: Fracture, Lower limb, ORIF, Tourniquet, Trauma, Orthopedics
SGUL Research Institute / Research Centre: Academic Structure > Institute of Medical & Biomedical Education (IMBE)
Journal or Publication Title: Eur J Orthop Surg Traumatol
ISSN: 1633-8065
Language: eng
Dates:
DateEvent
July 2021Published
1 April 2021Published Online
21 March 2021Accepted
Publisher License: Creative Commons: Attribution 4.0
PubMed ID: 33792771
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/113127
Publisher's version: https://doi.org/10.1007/s00590-021-02957-7

Actions (login required)

Edit Item Edit Item