Tourniquet use in routine primary total knee arthroplasty is associated with a higher transfusion rate and longer postop
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RESEARCH ARTICLE
Open Access
Tourniquet use in routine primary total knee arthroplasty is associated with a higher transfusion rate and longer postoperative length of stay: a real-world study Hong Xu1†, Jingli Yang2†, Jinwei Xie1†, Zeyu Huang3, Qiang Huang3, Guorui Cao3 and Fuxing Pei3*
Abstract Background: In an enhanced recovery after surgery program, a growing number of orthopedists are reconsidering the necessity of tourniquet use in total knee arthroplasty (TKA). However, the impact of tourniquet use on transfusion rate and postoperative length of stay (PLOS) in TKA remains controversial. Therefore, we carried out a study to investigate the effect of tourniquet application in routine primary TKA on transfusion rate and PLOS. Methods: We analyzed data from 6325 patients who underwent primary unilateral TKA and divided them into two groups according to whether a tourniquet was applied during the procedure, and a tourniquet was used in 4902 and not used in 1423. The information for transfusion and PLOS was extracted from patients’ electronic health records, and the data were analyzed with logistic and linear regression analyses. Results: Following TKA, the transfusion rate and PLOS were 14.52% and 7.72 ± 3.54 days, respectively, in the tourniquet group, and 6.47% and 6.44 ± 3.48 days, respectively, in the no-tourniquet group. After adjusting for the different related variables, tourniquet use was significantly correlated with a higher transfusion rate (risk ratio = 1.888, 95% confidence interval (CI) 1.449–2.461, P < 0.001) and a longer PLOS (partial regression coefficient (B) = 0.923, 95%CI 0.690–1.156, P < 0.001). Conclusions: Our findings suggested that tourniquet use in routine primary TKA was related to a higher transfusion rate and a longer PLOS. The impact of tourniquet use on transfusion rate and PLOS should be taken into account in clinical practice. Keywords: Tourniquet, Knee, Arthroplasty, Transfusion, Length of stay Total knee arthroplasty (TKA) is considered one of the most successful orthopedic surgical treatments for end* Correspondence: [email protected] † Hong Xu, Jingli Yang and Jinwei Xie, co-first authors, these three authors contributed to this article equally. 3 Department of Orthopaedic surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou district, Chengdu 610041, China Full list of author information is available at the end of the article
stage knee diseases because it can relieve pain, improve lower limb function, and improve patients’ quality of life [1, 2]. Tourniquets have been used in TKA since the procedure was first introduced [3, 4]. Until 2011, tourniquets were used in approximately 90% of the 12,048 primary TKAs performed in Sweden [5]. Proponents of tourniquet use in TKA believe that it can reduce intraoperative bleeding volume (which potentially offers a
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