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

Pelle Baggesgaard Petersen; Mette Mikkelsen; Christoffer Calov Jørgensen; Andreas Kappel; Anders Troelsen; Henrik Kehlet; Kirill Gromov; Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group; Mikkel Rathsach Andersen; Henrik Palm

doi:10.2340/17453674.2023.13793

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

Pelle Baggesgaard Petersen^*, Mette Mikkelsen, Christoffer Calov Jørgensen, Andreas Kappel, Anders Troelsen, Henrik Kehlet, Kirill Gromov, Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group, Mikkel Rathsach Andersen (Member of study group), Henrik Palm (Member of study group)

^*Corresponding author for this work

1 Citation (Scopus)

Abstract

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.

Original language	English
Journal	Acta Orthopaedica
Volume	94
Pages (from-to)	342-347
Number of pages	6
ISSN	1745-3674
DOIs	https://doi.org/10.2340/17453674.2023.13793
Publication status	Published - 2023

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Petersen, P. B., Mikkelsen, M., Jørgensen, C. C., Kappel, A., Troelsen, A., Kehlet, H., Gromov, K., Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group, Andersen, M. R., & Palm, H. (2023). 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 , 94, 342-347. https://doi.org/10.2340/17453674.2023.13793

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. / Petersen, Pelle Baggesgaard; Mikkelsen, Mette; Jørgensen, Christoffer Calov et al.
In: Acta Orthopaedica , Vol. 94, 2023, p. 342-347.

Research output: Contribution to journal › Journal article › Research › peer-review

Petersen, PB, Mikkelsen, M, Jørgensen, CC, Kappel, A, Troelsen, A , Kehlet, H , Gromov, K, Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group, Andersen, MR & Palm, H 2023, '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 , vol. 94, pp. 342-347. https://doi.org/10.2340/17453674.2023.13793

@article{88482660df8640599bbae6607d79e274,

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",

abstract = "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.",

author = "Petersen, {Pelle Baggesgaard} and Mette Mikkelsen and J{\o}rgensen, {Christoffer Calov} and Andreas Kappel and Anders Troelsen and Henrik Kehlet and Kirill Gromov and {Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group} and Andersen, {Mikkel Rathsach} and Henrik Palm",

year = "2023",

doi = "10.2340/17453674.2023.13793",

language = "English",

volume = "94",

pages = "342--347",

journal = "Acta Orthopaedica ",

issn = "1745-3674",

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TY - JOUR

T1 - Use of a tourniquet is not associated with increased risk of venous thromboembolism after fast-track total knee arthroplasty

T2 - a prospective multicenter cohort study of 16,250 procedures

AU - Petersen, Pelle Baggesgaard

AU - Mikkelsen, Mette

AU - Jørgensen, Christoffer Calov

AU - Kappel, Andreas

AU - Troelsen, Anders

AU - Kehlet, Henrik

AU - Gromov, Kirill

AU - Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group

A2 - Andersen, Mikkel Rathsach

A2 - Palm, Henrik

PY - 2023

Y1 - 2023

N2 - 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.

AB - 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.

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U2 - 10.2340/17453674.2023.13793

DO - 10.2340/17453674.2023.13793

M3 - Journal article

C2 - 37417882

SN - 1745-3674

VL - 94

SP - 342

EP - 347

JO - Acta Orthopaedica

JF - Acta Orthopaedica

ER -

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

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