Wyland AE, Woelber E, Wong LH, Arakawa J, Working ZM, Meeker J. Association between tourniquet use and intraoperative blood loss during below-knee amputation. World J Orthop 2022; 13(7): 644-651 [PMID: 36051373 DOI: 10.5312/wjo.v13.i7.644]
Corresponding Author of This Article
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
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Wyland AE, Woelber E, Wong LH, Arakawa J, Working ZM, Meeker J. Association between tourniquet use and intraoperative blood loss during below-knee amputation. World J Orthop 2022; 13(7): 644-651 [PMID: 36051373 DOI: 10.5312/wjo.v13.i7.644]
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.
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
ARTICLE HIGHLIGHTS
Research background
Below-knee amputation (BKA) is common procedure in the orthopedic population. Etiology for patients requiring this surgery are primarily trauma, infection, and neoplastic disease. There is currently no consensus among orthopedic surgeons regarding the use of a tourniquet in these patients.
Research motivation
The motivation behind this study is to determine a possible method to minimize blood loss in BKA operations.
Research objectives
To compare blood loss between patients who received a tourniquet during their BKA procedure and those who did not.
Research methods
We performed a retrospective cohort study on consecutive patients who underwent BKA over a ten-year period at a tertiary care hospital. Blood loss was estimated using the Nadler equation for preoperative blood volume and a novel formula that utilizes preoperative and postoperative hemoglobin levels and transfusions. Univariate and forwards stepwise multivariate linear regression were utilized to determine an association between tourniquet use and blood loss.
Research results
We found that patients undergoing a BKA operation with tourniquet use were associated with a 488 mL decrease in calculated blood loss. This is significant for orthopedic surgeons wanting to minimize blood loss in BKA operations.
Research conclusions
This study utilized a calculated blood loss rather than the commonly utilized estimated blood loss, and proposes that a tourniquet should be used if orthopedic surgeons wish to minimize blood loss in BKA operation.
Research perspectives
Research should be conducted on a larger population across multiple centers to determine a stronger association and increase external validity.
