Use of a tourniquet is not associated with increased risk of venous thromboembolism after fast-track total knee arthroplasty: a prospective multicenter cohort study of 16,250 procedures
Background and purpose: Venous thromboembolism (VTE) is a serious postoperative complication after total knee arthroplasty (TKA). Use of a tourniquet has shown conflicting results for risk of VTE after TKA. We aimed to investigate the associated risk of VTE after TKA using tourniquet in a fast-trac...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Medical Journals Sweden
2023-07-01
|
| Series: | Acta Orthopaedica |
| Subjects: | |
| Online Access: | https://actaorthop.org/actao/article/view/13793 |
| _version_ | 1797785238767665152 |
|---|---|
| author | Pelle Baggesgaard Petersen Mette Mikkelsen Christoffer Calov Jørgensen Andreas Kappel Anders Troelsen Henrik Kehlet Kirill Gromov |
| author_facet | Pelle Baggesgaard Petersen Mette Mikkelsen Christoffer Calov Jørgensen Andreas Kappel Anders Troelsen Henrik Kehlet Kirill Gromov |
| author_sort | Pelle Baggesgaard Petersen |
| collection | DOAJ |
| description |
Background and purpose: Venous thromboembolism (VTE) is a serious postoperative complication after total knee arthroplasty (TKA). Use of a tourniquet has shown conflicting results for risk of VTE after TKA. We aimed to investigate the associated risk of VTE after TKA using tourniquet in a fast-track set-up as no previous data exists.
Patients and methods: We performed an observational cohort study from 9 fast-track centers including unilateral primary TKA from 2010–2017 with prospective collection of preoperative risk-factors and complete 90-day follow-up. Use of a tourniquet was registered in the Danish Knee Arthroplasty Register. Postoperative VTE was identified from health records. We performed risk analyses using a mixed-effects logistic regression model adjusting for previously identified risk factors.
Results: Of the 16,250 procedures (39% males, mean age 67.9 [SD 10.0] years, median LOS 2 [interquartile range 2–3]) 12,518 (77%) were performed with a tourniquet. The annual tourniquet usage varied greatly between departments from 0% to 100%, but also within departments from 0% to 99%. There was no significant difference between the 2 groups with 52 (0.42%) VTEs in the tourniquet group vs. 25 (0.67%) in the no-tourniquet group (p = 0.06 for cumulative 90-day incidence of VTE). This association remained statistically insignificant for VTE using tourniquet after adjustment for previously identified risk factors.
Conclusion: We found no association between the use of a tourniquet and increased risk of 90-day VTE after primary fast-track TKA, irrespective of the length of time for which the tourniquet was applied.
|
| first_indexed | 2024-03-13T00:51:15Z |
| format | Article |
| id | doaj.art-64ee986e4c6444a2a762a1fed9fd684b |
| institution | Directory Open Access Journal |
| issn | 1745-3674 1745-3682 |
| language | English |
| last_indexed | 2024-03-13T00:51:15Z |
| publishDate | 2023-07-01 |
| publisher | Medical Journals Sweden |
| record_format | Article |
| series | Acta Orthopaedica |
| spelling | doaj.art-64ee986e4c6444a2a762a1fed9fd684b2023-07-07T13:43:11ZengMedical Journals SwedenActa Orthopaedica1745-36741745-36822023-07-019410.2340/17453674.2023.13793Use of a tourniquet is not associated with increased risk of venous thromboembolism after fast-track total knee arthroplasty: a prospective multicenter cohort study of 16,250 proceduresPelle Baggesgaard Petersen0Mette Mikkelsen1Christoffer Calov Jørgensen2Andreas Kappel3Anders Troelsen4Henrik Kehlet5Kirill Gromov6Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen; Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Rigshospitalet, CopenhagenLundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Rigshospitalet, CopenhagenSection for Surgical Pathophysiology, Rigshospitalet, Copenhagen; Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Rigshospitalet, CopenhagenDepartment of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, DenmarkDepartment of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre, HvidovreSection for Surgical Pathophysiology, Rigshospitalet, Copenhagen; Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Rigshospitalet, CopenhagenLundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Rigshospitalet, Copenhagen; Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Hvidovre Background and purpose: Venous thromboembolism (VTE) is a serious postoperative complication after total knee arthroplasty (TKA). Use of a tourniquet has shown conflicting results for risk of VTE after TKA. We aimed to investigate the associated risk of VTE after TKA using tourniquet in a fast-track set-up as no previous data exists. Patients and methods: We performed an observational cohort study from 9 fast-track centers including unilateral primary TKA from 2010–2017 with prospective collection of preoperative risk-factors and complete 90-day follow-up. Use of a tourniquet was registered in the Danish Knee Arthroplasty Register. Postoperative VTE was identified from health records. We performed risk analyses using a mixed-effects logistic regression model adjusting for previously identified risk factors. Results: Of the 16,250 procedures (39% males, mean age 67.9 [SD 10.0] years, median LOS 2 [interquartile range 2–3]) 12,518 (77%) were performed with a tourniquet. The annual tourniquet usage varied greatly between departments from 0% to 100%, but also within departments from 0% to 99%. There was no significant difference between the 2 groups with 52 (0.42%) VTEs in the tourniquet group vs. 25 (0.67%) in the no-tourniquet group (p = 0.06 for cumulative 90-day incidence of VTE). This association remained statistically insignificant for VTE using tourniquet after adjustment for previously identified risk factors. Conclusion: We found no association between the use of a tourniquet and increased risk of 90-day VTE after primary fast-track TKA, irrespective of the length of time for which the tourniquet was applied. https://actaorthop.org/actao/article/view/13793Arthroplastyfast-trackKneetourniquet |
| spellingShingle | Pelle Baggesgaard Petersen Mette Mikkelsen Christoffer Calov Jørgensen Andreas Kappel Anders Troelsen Henrik Kehlet Kirill Gromov Use of a tourniquet is not associated with increased risk of venous thromboembolism after fast-track total knee arthroplasty: a prospective multicenter cohort study of 16,250 procedures Acta Orthopaedica Arthroplasty fast-track Knee tourniquet |
| title | Use of a tourniquet is not associated with increased risk of venous thromboembolism after fast-track total knee arthroplasty: a prospective multicenter cohort study of 16,250 procedures |
| title_full | Use of a tourniquet is not associated with increased risk of venous thromboembolism after fast-track total knee arthroplasty: a prospective multicenter cohort study of 16,250 procedures |
| title_fullStr | Use of a tourniquet is not associated with increased risk of venous thromboembolism after fast-track total knee arthroplasty: a prospective multicenter cohort study of 16,250 procedures |
| title_full_unstemmed | Use of a tourniquet is not associated with increased risk of venous thromboembolism after fast-track total knee arthroplasty: a prospective multicenter cohort study of 16,250 procedures |
| title_short | Use of a tourniquet is not associated with increased risk of venous thromboembolism after fast-track total knee arthroplasty: a prospective multicenter cohort study of 16,250 procedures |
| title_sort | use of a tourniquet is not associated with increased risk of venous thromboembolism after fast track total knee arthroplasty a prospective multicenter cohort study of 16 250 procedures |
| topic | Arthroplasty fast-track Knee tourniquet |
| url | https://actaorthop.org/actao/article/view/13793 |
| work_keys_str_mv | AT pellebaggesgaardpetersen useofatourniquetisnotassociatedwithincreasedriskofvenousthromboembolismafterfasttracktotalkneearthroplastyaprospectivemulticentercohortstudyof16250procedures AT mettemikkelsen useofatourniquetisnotassociatedwithincreasedriskofvenousthromboembolismafterfasttracktotalkneearthroplastyaprospectivemulticentercohortstudyof16250procedures AT christoffercalovjørgensen useofatourniquetisnotassociatedwithincreasedriskofvenousthromboembolismafterfasttracktotalkneearthroplastyaprospectivemulticentercohortstudyof16250procedures AT andreaskappel useofatourniquetisnotassociatedwithincreasedriskofvenousthromboembolismafterfasttracktotalkneearthroplastyaprospectivemulticentercohortstudyof16250procedures AT anderstroelsen useofatourniquetisnotassociatedwithincreasedriskofvenousthromboembolismafterfasttracktotalkneearthroplastyaprospectivemulticentercohortstudyof16250procedures AT henrikkehlet useofatourniquetisnotassociatedwithincreasedriskofvenousthromboembolismafterfasttracktotalkneearthroplastyaprospectivemulticentercohortstudyof16250procedures AT kirillgromov useofatourniquetisnotassociatedwithincreasedriskofvenousthromboembolismafterfasttracktotalkneearthroplastyaprospectivemulticentercohortstudyof16250procedures |