Background and Aims The pneumatic tourniquet is frequently employed in the orthopedic surgery. This device creates a bloodless surgical field, decreasing perioperative blood loss and procedure duration. However, this technique can also be associated with complications if improperly applied.

We aimed to assess the good practices of the tourniquet employment in a high-volume orthopaedic centre.

Methods Retrospective analysis of patients who underwent orthopaedic limb surgery with tourniquet technique from October to December 2019. Baseline patient and intraprocedural data was collected and analysed, as well as surgical complications and known contraindications. The relationship between baseline systolic arterial pressure (SBP) and tourniquet pressure (TP) was assessed with the Spearman correlation coefficient, and subsets of patients were compared with the Mann-Whitney test.

Results A total of 216 patients (37% men, median age 53, IQR 40–67 years) were included. The majority were ASA II (69%), 28% were obese (BMI>30), and the prevalence of comorbidities was substantial (see table 1). Median TP was 350 mmHg (IQR 250–360mmHg), and all but 2 patients were under occlusion pressure for more than 120 minutes. Tourniquet was used in 3 patients with venous thrombosis history and 3 with rheumatoid arthritis. SBP and TP were not correlated (r=0.031, p=0.650). However, TP were higher in hypertensive patients (p=0.007). The complication rate was low (3 wound infections, 1 deep venous thrombosis and 1 neuropathic pain).

Conclusions In our centre the tourniquet employment was a safe practice. TP tailoring accordingly to SBP can still be optimized, especially in the hypertensive population.

Local committee authorized this study.