Perioperative Arthroscopic Tourniquet Usage: Practices and Trends of the AANA Membership Are Varied

TL;DR

This study explores how AANA members use tourniquets during arthroscopy, finding varied practices and highlighting the need for safer, standardized approaches.

Contribution

The paper provides insights into current tourniquet practices and identifies trends toward safer, selective inflation techniques.

Findings

Most respondents use tourniquets for all limb procedures but vary in inflation practices.

Selective inflation reduced tourniquet times to 15-20 minutes compared to continuous inflation.

Many respondents are interested in using tourniquet technology to address postsurgical lymphedema.

Abstract

To investigate current practices for tourniquet use, including tourniquet times, indications, and other perioperative applications, among Arthroscopy Association of North America (AANA) members and to determine whether recommendations can be made for safer tourniquet use.

Participants in this study were AANA members who responded to our survey in the AANA DocMatter Community. The survey was developed based on discussion prompts in DocMatter. The survey consisted of 28 questions on 4 core themes, including demographic characteristics, general understanding of tourniquet safety, applied tourniquet use in arthroscopy, and tourniquet technology in perioperative applications. The survey was open for responses for 7 weeks from September to November 2023. Multiple-choice responses were counted, and short-form responses were reviewed and aggregated based on keywords. Qualitative analysis was used to understand the data.

A total of 59 AANA DocMatter Community Members participated in the survey. Eighty percent of respondents had been in practice for more than 10 years, whereas 20% had been in practice for between 3 and 10 years. Tourniquet usage in arthroscopy was varied, although some patterns were detected. For example, 91% of responders applied tourniquets for all limb procedures, but many inflated them only as needed, and some preferred not to use a tourniquet. When tourniquet times were minimized by selectively inflating cuffs, tourniquet times averaged between 15 and 20 minutes compared with 20 to 60 minutes for continuous inflation. However, 76% of participants reported encountering venous congestion when a tourniquet was applied but not inflated. Perioperative tourniquet uses were also varied. Almost half of respondents used tourniquets for blood flow restriction therapy in their care protocols. In a separate possible trend, a majority of respondents were interested in using tourniquet-related technology to help resolve postsurgical lymphedema.

Despite large reported variation in the indications for tourniquet use and the control of key tourniquet parameters, use is evolving through a focus on optimizing tourniquet times through selective inflation for specific aspects of arthroscopic procedures.

Standardized approaches to the safe use of tourniquets and their evolving applications are important areas of investigation.