860 Intra-Operative Tourniquet Use in Elective Trauma & Orthopaedic Surgery – Do We Accept or Reject Guidelines? (A Multi-Centre Clinical Audit)

Abstract

Abstract Aim Pneumatic tourniquets are used in Trauma & Orthopaedic (T&O) surgery to provide a bloodless field. Their use can give rise to preventable complications. British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) 2021 guidelines aim to improve tourniquet safety, highlighting strict documentation and pressure based on intra-operative blood pressure. We evaluated intra-operative tourniquet use in elective T&O surgeries across 3 centres in North London, focusing on adherence to BOAST guidelines. Method One month of elective T&O surgeries employing tourniquet were reviewed, totalling 88 cases (17 upper limb, 71 lower limb). Tourniquet pressure ranges were calculated from anaesthetist intra-operative blood pressure records. Tourniquet documentation was retrieved from scrub-nurse, anaesthetist, and surgeon operative records. Adherence to BOAST guidelines was assessed. Results 14.0% of surgeon notes did not comment on tourniquet use and 86% had incomplete documentation. 97.6% of nursing notes had incomplete documentation. Average tourniquet pressure was 237 mmHg (SD ± 21.6) and 261.7 mmHg (SD ± 25.3) for upper and lower limb surgery, respectively. Upper limb tourniquet pressure was above guideline recommendations in 70% of cases. Mean pressure was 12.5 mmHg above calculated maximal pressure (95% CI -7.98 - 32.98; P = 0.22). Half (47.5%) of lower limb pressures were above maximal calculated pressure. Tourniquet pressure was on average 5.6 mmHg above guidelines (95% CI -4.12 - 15.26, P = 0.26). Conclusions Tourniquet use is poorly documented, which does not comply with BOAST guidance. Inappropriately high torniquet pressures may lead to preventable complications. Education on current guidelines is pertinent to improve adherence to national standards.