OP18 A systematic review and meta-analysis of tourniquet use during major lower limb amputation for complications of peripheral arterial disease

Résumé fourni par la source

Objective Intraoperative blood loss is a significant complication of major lower limb amputation (MLLA). However, tourniquet use in peripheral arterial disease (PAD) remains contentious. This meta-analysis assessed the effect of tourniquet use on PAD patient outcomes following MLLA.Methods EMBASE, Medline and Cochrane were searched. Inclusion criteria were any study design reporting outcomes of MLLA for PAD with and without tourniquet use. Papers were pooled using random effects meta-analysis.Results Six studies were included, totalling 921 patients. Postoperative Hb drop was significantly reduced for tourniquet patients (MD -0.55; 95%CI -0.80 to -0.31; P<0.0001). OR for requiring blood transfusion was 0.58 (95%CI 0.31 to 1.10; P=0.10) in the tourniquet versus non-tourniquet groups, whilst number of units transfused per patient were lower (MD -0.35; 95%CI -0.74 to 0.04; P=0.08). Operation length was significantly reduced in tourniquet patients (MD -8.69; 95%CI -15.95 to -1.42; P=0.02). There was no significant difference in surgical site infection (SSI) (OR 1.07; 95%CI 0.60 to 1.90; P=0.82), stump revision (SR) (OR 0.73; 95%CI 0.41 to 1.30; P=0.29), and death (OR 0.80; 95%CI 0.49 to 1.30; P=0.36) in the tourniquet versus non-tourniquet cohort.Conclusions Tourniquet use during MLLA significantly reduces blood loss and operative duration, with no significant difference in SSI, SR and mortality. Further RCTs are needed to generate higher quality evidence which may change practice.

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