Trans tibial amputation with or without a tourniquet in patients with diabetic foot infection and peripheral vascular disease: Comparison of postoperative outcomes

Background: Transtibial amputation (TTA) due to complications of diabetic foot infection (DFI) or peripheral vascular disease (PVD) is a high-risk procedure in fragile patients. The risks of reoperation, blood loss requiring blood transfusion, and mortality are high. The use of a tourniquet in this...

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Bibliographic Details
Published in:Journal of orthopaedic surgery (Hong Kong) 2022-05, Vol.30 (2), p.10225536221102694-10225536221102694
Main Authors: Gurel, Ron, Elbaz, Etay, Ashkenazi, Itay, Rotman, Dani, Factor, Shai, Chechik, Ofir, Warschawski, Yaniv, Albagli, Assaf
Format: Article
Language:English
Subjects:
Blood transfusions
Diabetes
Foot diseases
Hospitalization
Infections
Mortality
Postoperative period
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Summary:Background: Transtibial amputation (TTA) due to complications of diabetic foot infection (DFI) or peripheral vascular disease (PVD) is a high-risk procedure in fragile patients. The risks of reoperation, blood loss requiring blood transfusion, and mortality are high. The use of a tourniquet in this procedure is controversial and scarcely reported. Objective: this study aimed to compare the outcomes of TTAs with or without a tourniquet in a single tertiary medical center. Methods: We retrospectively identified all patients who had undergone TTA in our institution (1/2019-1/2020) and included only those who underwent the procedure due to complications of DFI or PVD (n = 69). The retrieved data included demographics, comorbidities, ASA score, the use of a tourniquet, operation duration, pre- and postoperative hemoglobin levels, administration of blood transfusions, hospitalization length, surgical site infection and 60-days reoperation and mortality rates. Results: TTA with a tourniquet was superior to TTA without a tourniquet in reducing the average operation length by 11 min (p = 0.05), the median postoperative hospitalization by 6 days (p = 0.04), and the use of blood transfusions (odds ratio [OR] = 0.176, 95% confidence interval [CI]: 0.031–0.996). Conclusions: Our findings demonstrated advantages in operative time, hospitalization length, and blood transfusion requirement for TTA with a tourniquet compared to TTA without a tourniquet.
ISSN:1022-5536
2309-4990
DOI:10.1177/10225536221102694