Trans Tibial Amputation with or without a Tourniquet in Patients with Diabetic Foot Infection and Peripheral Vascular Disease: Comparison of Postoperative Outcomes

Background:
Transtibial amputation (TTA) due to complications of diabetic foot infection (DFI) or peripheral vascular disease (PVD) is a high-risk procedure in fragile patients. The risks of reoperation, blood loss requiring blood transfusion, and mortality are high. The use of a tourniquet in this procedure is controversial and scarcely reported. This study aimed to compare the outcomes of TTAs with or without a tourniquet in a single tertiary medical center.

Methods:
We retrospectively identified all patients who had undergone TTA in our institution (1/2019-1/2020) and included only those who underwent the procedure due to complications of DFI or PVD (n = 69). The retrieved data included demographics, comorbidities, ASA score, the use of a tourniquet, operation duration, pre- and postoperative hemoglobin levels, administration of blood transfusions, hospitalization length, and 60-day reoperation and mortality rates.

Results:
TTA with a tourniquet was superior to TTA without a tourniquet in reducing the average operation length by 11 minutes (P = 0.05), the median postoperative hospitalization by 6 days (P = 0.04), and the use of blood transfusions (odds ratio [OR]=0.176, 95% confidence interval [CI]: 0.031-0.996). Multivariate logistic regression analysis of comorbidities showed ORs for mortality and reoperation within 60 days of 0.33 (P = 0.057, 95% CI: 0.001-1.112) and 0.212 (P = 0.154, 95% CI: 0.025-1.79), respectively.

Conclusions:
Our findings demonstrated advantages in operative time, hospitalization, and blood transfusion requirement for TTA with a tourniquet compared to TTA without a tourniquet. Further investigations of the impact of tourniquet use in TTA on postoperative outcome parameters are warranted.