Impact of Tourniquet Use in Major Lower Limb Amputation: A Systematic Review and Meta-analysis.

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery Pub Date : 2024-09-16 DOI:10.1016/j.ejvs.2024.09.017

Jessie Shea,Elisabeth Smith,Megan Lyons,Monty Fricker,Ryan Laloo,David C Bosanquet

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引用次数: 0

Abstract

OBJECTIVE Intra-operative blood loss is a significant complication of major lower limb amputation (MLLA). This systematic review and meta-analysis assessed the effect of tourniquet use on patients undergoing amputation. DATA SOURCES Embase, MEDLINE, and Cochrane databases were searched from inception to April 2024. REVIEW METHODS Inclusion criteria were any study design assessing MLLA with and without tourniquet use. Primary outcomes were peri-operative blood loss and transfusion requirements. Secondary outcomes were operative duration, surgical site infection, stump revision, and death. Articles were screened and data extracted independently by two reviewers, then pooled using random effects meta-analysis, and presented with their GRADE certainty. Risk of bias was assessed using ROBINS-I and Cochrane RoB 2 tools. RESULTS Seven studies (one randomised controlled trial [RCT] and six cohort studies) were included, totalling 1 018 limbs (412 tourniquet, 606 non-tourniquet). Intra-operative blood loss was lower with tourniquet use (mean difference [MD] -192.09 mL; 95% confidence interval [CI] -291.67 - -92.52; p < .001); however, there was no statistically significant difference in total blood loss measured over the first three to four post-operative days (MD -254.66 mL; 95% CI -568.12 - 58.80; p = .11). Post-operative haemoglobin decrease was lower for tourniquet patients (MD -0.55 g/dL; 95% CI -0.80 - -0.31; p < .001). The odds ratio (OR) for requiring blood transfusion was 0.65 (95% CI 0.38 - 1.11; p = .11) for tourniquet vs. non-tourniquet patients, with no statistically significant difference in number of units transfused per patient (MD -0.35, 95% CI -0.72 - 0.03; p = .070). Operation length was shorter with tourniquet use (MD -8.69 minutes, 95% CI -15.95 - -1.42; p = .020). There was no statistically significant difference in rates of surgical site infection (OR 1.07, 95% CI 0.60 - 1.90; p = .82), stump revision (OR 0.71, 95% CI 0.43 - 1.16; p = .17), or death (OR 0.80, 95% CI 0.49 - 1.30; p = .36). GRADE certainty was low or very low for all outcomes. CONCLUSION Tourniquet use may be associated with reduced post-operative haemoglobin decrease and operative duration, without negative consequences on stump infection, revision, and mortality. However, most data are observational. Further RCTs are needed to generate higher quality evidence.

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止血带使用对下肢大截肢的影响：系统回顾与元分析》。

目的术中失血是下肢大截肢（MLLA）的一个重要并发症。本系统综述和荟萃分析评估了使用止血带对截肢患者的影响。资料来源检索了从开始到 2024 年 4 月的 Embase、MEDLINE 和 Cochrane 数据库。主要结果是围手术期失血量和输血需求。次要结果为手术持续时间、手术部位感染、残端翻修和死亡。文章由两名审稿人独立筛选和提取数据，然后使用随机效应荟萃分析进行汇总，并以 GRADE 确定性进行展示。结果共纳入七项研究（一项随机对照试验 [RCT] 和六项队列研究），共计 1 018 个肢体（412 个止血带，606 个非止血带）。使用止血带的术中失血量较低（平均差 [MD] -192.09 mL；95% 置信区间 [CI] -291.67 --92.52；p < .001）；然而，术后头三到四天的总失血量没有显著的统计学差异（平均差 [MD] -254.66 mL；95% 置信区间 [CI] -568.12 --58.80；p = .11）。止血带患者的术后血红蛋白下降率较低（MD -0.55 g/dL；95% CI -0.80--0.31；p < .001）。止血带患者与非止血带患者需要输血的几率比（OR）为 0.65 (95% CI 0.38 - 1.11; p = .11)，每位患者输血单位数的差异无统计学意义（MD -0.35, 95% CI -0.72 - 0.03; p = .070）。使用止血带的手术时间更短（MD -8.69 分钟，95% CI -15.95 - -1.42; p = .020）。手术部位感染率（OR 1.07，95% CI 0.60 - 1.90；P = .82）、残端翻修率（OR 0.71，95% CI 0.43 - 1.16；P = .17）或死亡率（OR 0.80，95% CI 0.49 - 1.30；P = .36）差异无统计学意义。结论使用止血带可能与术后血红蛋白下降和手术时间缩短有关，但不会对残端感染、翻修和死亡率产生负面影响。然而，大多数数据都是观察性的。需要进一步进行研究性试验，以获得更高质量的证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Vascular and Endovascular Surgery 医学-外科

CiteScore

6.80

自引率

15.80%

发文量

471

审稿时长

66 days

期刊介绍： The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles. Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.