Effect on hospital length of stay of tourniquet use during internal fixation of ankle fracture: randomized controlled trial

Abstract

Approximately 50% of ankle fractures require internal fixation. A tourniquet is often employed to create a bloodless operative field, but its effect on hospital length of stay (LOS) is unclear. This paper reports a parallel-group observer-blinded randomized trial of the effect of tourniquet use on LOS. 188 adult patients requiring internal fixation of ankle fracture were randomized to surgery with or without tourniquet. LOS was analyzed on intention-to-treat principles using Poisson regression. As a secondary outcome, duration of operation was analyzed by ANCOVA. Mean LOS was 1.79 ±1.50 days in the tourniquet group and 1.65 ±1.11 days in the no-tourniquet group. The covariate-adjusted rate ratio for LOS (reference group: no tourniquet) was 1.084 (95% CI 0.871, 1.348; p = .470). Sensitivity analyses (unadjusted intention-to-treat analysis and as-treated analysis) gave similar non-significant results. The covariate-adjusted mean difference in duration of operation was 3.03 minutes (95% CI –4.96, 11.02; p = .455), favoring the tourniquet group; sensitivity analyses again gave similar results. Adverse events did not differ significantly between groups. In conclusion, the use of a tourniquet during internal fixation does not significantly influence hospital LOS, of which pre-injury medical condition of the patient appears to be the most important determinant.