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Timing of tourniquet release in total knee arthroplasty: A meta-analysis

BACKGROUND: For total knee arthroplasty (TKA), the tourniquet is routinely employed for better visualization, less blood loss, and easier cementation. However, the time to release tourniquet remains controversial. Therefore, we performed current meta-analysis to assess whether releasing tourniquet b...

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Autores principales: Zhang, Pei, Liang, Yuan, He, Jinshan, Fang, Yongchao, Chen, Pengtao, Wang, Jingcheng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5413282/
https://www.ncbi.nlm.nih.gov/pubmed/28445317
http://dx.doi.org/10.1097/MD.0000000000006786
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author Zhang, Pei
Liang, Yuan
He, Jinshan
Fang, Yongchao
Chen, Pengtao
Wang, Jingcheng
author_facet Zhang, Pei
Liang, Yuan
He, Jinshan
Fang, Yongchao
Chen, Pengtao
Wang, Jingcheng
author_sort Zhang, Pei
collection PubMed
description BACKGROUND: For total knee arthroplasty (TKA), the tourniquet is routinely employed for better visualization, less blood loss, and easier cementation. However, the time to release tourniquet remains controversial. Therefore, we performed current meta-analysis to assess whether releasing tourniquet before wound closure is more effective in reducing blood loss than releasing tourniquet after wound closure in TKA without an increased risk of complications. METHODS: To conduct this meta-analysis, we searched Medline, Embase, Web of science, and the Cochrane library up to November 2016, for randomized controlled trials comparing tourniquet releasing before and after wound closure in TKA. A meta-analysis was performed following the guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement. Methodological quality of the trials was assessed using the Cochrane risk assessment scale. The data of the included studies were analyzed using Stata 12.0. RESULTS: Sixteen trials involving 1010 patients were identified in current meta-analysis. Our meta-analysis demonstrated that there were no significant differences in the 2 groups in terms of calculated blood loss (weighted mean difference [WMD] = 160.65, 95% confidence interval [CI]: −0.2 to 321.49, P = .05), postoperative blood loss (WMD = −45.41, 95% CI: −120.11 to 29.29, P = .233),postoperative hemoglobin decline (WMD = 0.16, 95% CI: −2.5 to 2.82, P = .905), transfusion volume (WMD = 79.19, 95% CI: −5.05 to 163.44, P = .065),transfusion rates (relative risk [RR] = 1.19, 95% CI: 0.95–1.50, P = .134), major complications (RR = 0.51, 95% CI: 0.15–1.73, P = .278), and deep vein thrombosis (RR = 0.44, 95% CI: 0.14–1.37, P = .157).Compared with the group of releasing tourniquet after wound closure, the group of releasing tourniquet before wound closure had a higher volume of total blood loss (WMD = 130.96, 95% CI: 58.83–203.09, P = .000) and a longer operation time (WMD = 6.56, 95% CI: 3.12–10.01, P = .000). However, releasing tourniquet before wound closure could reduce minor complications (RR = 0.53, 95% CI: 0.34–0.82, P = .004). CONCLUSIONS: On the basis of current meta-analysis, the method of releasing tourniquet before wound closure could increase total blood loss and operation time; nevertheless, the risk of complications decreased. Thus, if patients are in severe anemia condition, the tourniquet perhaps should be released after wound closure to decrease blood loss. In contrary, releasing tourniquet before wound closure to decrease the risk of complications would be a better choice.
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spelling pubmed-54132822017-05-05 Timing of tourniquet release in total knee arthroplasty: A meta-analysis Zhang, Pei Liang, Yuan He, Jinshan Fang, Yongchao Chen, Pengtao Wang, Jingcheng Medicine (Baltimore) 7100 BACKGROUND: For total knee arthroplasty (TKA), the tourniquet is routinely employed for better visualization, less blood loss, and easier cementation. However, the time to release tourniquet remains controversial. Therefore, we performed current meta-analysis to assess whether releasing tourniquet before wound closure is more effective in reducing blood loss than releasing tourniquet after wound closure in TKA without an increased risk of complications. METHODS: To conduct this meta-analysis, we searched Medline, Embase, Web of science, and the Cochrane library up to November 2016, for randomized controlled trials comparing tourniquet releasing before and after wound closure in TKA. A meta-analysis was performed following the guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement. Methodological quality of the trials was assessed using the Cochrane risk assessment scale. The data of the included studies were analyzed using Stata 12.0. RESULTS: Sixteen trials involving 1010 patients were identified in current meta-analysis. Our meta-analysis demonstrated that there were no significant differences in the 2 groups in terms of calculated blood loss (weighted mean difference [WMD] = 160.65, 95% confidence interval [CI]: −0.2 to 321.49, P = .05), postoperative blood loss (WMD = −45.41, 95% CI: −120.11 to 29.29, P = .233),postoperative hemoglobin decline (WMD = 0.16, 95% CI: −2.5 to 2.82, P = .905), transfusion volume (WMD = 79.19, 95% CI: −5.05 to 163.44, P = .065),transfusion rates (relative risk [RR] = 1.19, 95% CI: 0.95–1.50, P = .134), major complications (RR = 0.51, 95% CI: 0.15–1.73, P = .278), and deep vein thrombosis (RR = 0.44, 95% CI: 0.14–1.37, P = .157).Compared with the group of releasing tourniquet after wound closure, the group of releasing tourniquet before wound closure had a higher volume of total blood loss (WMD = 130.96, 95% CI: 58.83–203.09, P = .000) and a longer operation time (WMD = 6.56, 95% CI: 3.12–10.01, P = .000). However, releasing tourniquet before wound closure could reduce minor complications (RR = 0.53, 95% CI: 0.34–0.82, P = .004). CONCLUSIONS: On the basis of current meta-analysis, the method of releasing tourniquet before wound closure could increase total blood loss and operation time; nevertheless, the risk of complications decreased. Thus, if patients are in severe anemia condition, the tourniquet perhaps should be released after wound closure to decrease blood loss. In contrary, releasing tourniquet before wound closure to decrease the risk of complications would be a better choice. Wolters Kluwer Health 2017-04-28 /pmc/articles/PMC5413282/ /pubmed/28445317 http://dx.doi.org/10.1097/MD.0000000000006786 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 7100
Zhang, Pei
Liang, Yuan
He, Jinshan
Fang, Yongchao
Chen, Pengtao
Wang, Jingcheng
Timing of tourniquet release in total knee arthroplasty: A meta-analysis
title Timing of tourniquet release in total knee arthroplasty: A meta-analysis
title_full Timing of tourniquet release in total knee arthroplasty: A meta-analysis
title_fullStr Timing of tourniquet release in total knee arthroplasty: A meta-analysis
title_full_unstemmed Timing of tourniquet release in total knee arthroplasty: A meta-analysis
title_short Timing of tourniquet release in total knee arthroplasty: A meta-analysis
title_sort timing of tourniquet release in total knee arthroplasty: a meta-analysis
topic 7100
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5413282/
https://www.ncbi.nlm.nih.gov/pubmed/28445317
http://dx.doi.org/10.1097/MD.0000000000006786
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