IS TOURNIQUET USE ASSOCIATED WITH A DIFFERENCE IN PATIENT-REPORTED OUTCOMES FOLLOWING TOTAL KNEE ARTHROPLASTY? A MULTICENTRE COMPARISON
Notice bibliographique
Résumé
Total knee arthroplasty (TKA) is one of the most commonly performed elective procedures in North America. It is expected that the annual volume of TKAs will continue to grow as indications expand and the population ages. While there have been advancements made in patient optimization, surgical technique and implant design there continues to be a subset of patients that remain unhappy with their outcome following TKA. The use of a tourniquet intraoperatively has been a contentious issue and thought to potentially contribute to this phenomenon. With patient reported outcome measures (PROMs) being routinely collected as a tool to assess quality, we sought to identify whether tourniquet use is associated with a difference in PROMs post-operatively. As part of the PEPPER Trial, a database of over 15,000 patients was used to identify patients who underwent primary TKA with or without a tourniquet between December 2016 to November 2022. Preoperative to postoperative changes in PROMs were assessed at 1, 3 and 6 months postoperatively. PROMs collection consisted of the Knee Osteoarthritis Outcome Score Jr. (KOOS-Jr), Patient-Reported Outcomes Measurement Information System Physical Health Summary (PROMIS-PH) and the Numerical Pain Rating Scale (NPRS). Mean Clinically Important Differences (MCID) were calculated for each PROM based on established criteria. Secondary outcome measures collected consisted of complications, healthcare utilization, opioid consumption and operative time. Statistical analysis was performed comparing patient cohorts via χ² and t-tests. Multivariable regression analysis was performed to identify patient and surgical factors that influence PROMs. 5684 patients underwent elective TKA and met criteria for this analysis. 4865 (85.6%) underwent surgery with a tourniquet (YT) and 818 (14.4%) underwent surgery without a tourniquet (NT). 28 sites across North America contributed patients to the study cohort. Patients who underwent TKA without a tourniquet were younger, less comorbid and more likely to receive a cementless component. There was no difference in operative time, length of stay or discharge destination. There was similarly no difference between NT and YT at any time point with respect to KOOS-JR, PROMIS-PH and NPRS. There was no difference in opioid consumption, wound related complications and readmissions postoperatively. The proportion of patients reaching the MCID for each given PROM increased with each time interval. However, between 24-53% of patients had not reached the MCID target by 6 months. In a large patient cohort there was no difference in PROMs, opioid consumption, healthcare utilization or complications in patients undergoing TKA with or without a tourniquet. With a large proportion of patients not meeting MCID targets by 6 months, the recovery from TKA continues to be evidently a long process. This further reinforces the need for appropriate patient education and expectation setting prior to TKA.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».