Abstract：
OBJECTIVE: Existing evidence estimates a twofold risk of venous thromboembolisms (VTEs) if tourniquet is applied during total knee arthroplasties (TKAs). However, this estimate relies on multiple trials with a low number of patients analyzing VTEs as a secondary outcome. We hypothesized that tourniquet-use increases the risk of symptomatic VTE within 90 days of contemporary primary TKA and aimed to use the extensive Danish healthcare registries to quantify this risk.
METHODS: Prospectively collected registry data from Danish patients receiving primary TKAs between 2014 and 2018 were included in the study. Patients were divided by tourniquet-use during surgery. By merging information from four nationwide registries, the study included 44 baseline characteristics with the potential to confound the association between tourniquet-use and VTE. Incidence rate and odds ratios were used to compare the risk of VTE within 90 days of surgery.
RESULTS: 19,804 patients of whom 10,111 (51%) were operated with tourniquet and 9693 (49%) without were included. The mean age (SD) was 70 (9) in both groups and 62% were females in the tourniquet group compared with 61% in the no tourniquet group. The groups were similarly comparable across all other baseline characteristics except type of post-operative thromboprophylaxis, type of anaesthesia, implant fixation, and year of surgery. The 90-days incidence of VTE was 0.77% (95% CI 0.60-0.94) in the tourniquet group compared with 1.10% (95% CI 0.90-1.31) in the no tourniquet group. Following adjustment for the unbalanced confounders, the odds ratio for VTE was 0.77 (95% CI 0.54-1.10) associated with tourniquet-use.
CONCLUSIONS: In contemporary TKAs the rate of VTE within 90 days is low and not significant altered by tourniquet-use. Thus, tourniquet can safely be applied during primary TKA-surgery without jeopardizing the risk of postoperative VTE.
METHODS: II-prospective cohort study.
METHODS: Prospectively collected registry data from Danish patients receiving primary TKAs between 2014 and 2018 were included in the study. Patients were divided by tourniquet-use during surgery. By merging information from four nationwide registries, the study included 44 baseline characteristics with the potential to confound the association between tourniquet-use and VTE. Incidence rate and odds ratios were used to compare the risk of VTE within 90 days of surgery.
RESULTS: 19,804 patients of whom 10,111 (51%) were operated with tourniquet and 9693 (49%) without were included. The mean age (SD) was 70 (9) in both groups and 62% were females in the tourniquet group compared with 61% in the no tourniquet group. The groups were similarly comparable across all other baseline characteristics except type of post-operative thromboprophylaxis, type of anaesthesia, implant fixation, and year of surgery. The 90-days incidence of VTE was 0.77% (95% CI 0.60-0.94) in the tourniquet group compared with 1.10% (95% CI 0.90-1.31) in the no tourniquet group. Following adjustment for the unbalanced confounders, the odds ratio for VTE was 0.77 (95% CI 0.54-1.10) associated with tourniquet-use.
CONCLUSIONS: In contemporary TKAs the rate of VTE within 90 days is low and not significant altered by tourniquet-use. Thus, tourniquet can safely be applied during primary TKA-surgery without jeopardizing the risk of postoperative VTE.
METHODS: II-prospective cohort study.
摘要：
目的：现有证据估计，如果在全膝关节置换术（TKAs）期间使用止血带，静脉血栓栓塞（VTE）的风险会增加两倍。然而,这一估计依赖于多项试验,这些试验的次要结局是分析VTEs的患者数量较少.我们假设使用止血带会在当代原发性TKA的90天内增加有症状的VTE风险，并旨在使用广泛的丹麦医疗保健注册表来量化这种风险。
方法：前瞻性收集2014年至2018年接受原发性TKAs的丹麦患者的注册数据纳入研究。手术期间使用止血带将患者分开。通过合并来自四个全国注册管理机构的信息，该研究包括44项基线特征,这些特征可能混淆止血带使用和VTE之间的关联.发生率和比值比用于比较手术后90天内VTE的风险。
结果：包括19,804例患者，其中10,111例（51％）使用止血带和9693例（49％）没有使用止血带。两组的平均年龄（SD）为70（9），止血带组的女性为62％，而无止血带组为61％。除术后血栓预防类型外，两组在所有其他基线特征方面具有相似的可比性。麻醉类型,植入物固定,和手术年份。止血带组的VTE90天发生率为0.77％（95％CI0.60-0.94），无止血带组为1.10％（95％CI0.90-1.31）。在调整不平衡的混杂因素后，与使用止血带相关的VTE比值比为0.77(95%CI0.54~1.10).
结论：在当代TKA中，90天内的VTE发生率很低，并且使用止血带没有明显改变。因此，在初次TKA手术期间可以安全地使用止血带，而不会危及术后VTE的风险。
方法：II-前瞻性队列研究。
方法：前瞻性收集2014年至2018年接受原发性TKAs的丹麦患者的注册数据纳入研究。
结果：包括19,804例患者，其中10,111例（51％）使用止血带和9693例（49％）没有使用止血带。
结论：在当代TKA中，90天内的VTE发生率很低，并且使用止血带没有明显改变。
方法：II-前瞻性队列研究。
