96 Looped Prospective Audit of Compliance to the British Orthopaedics Association Standards for Trauma and Orthopaedics (BOAST): Safe Use of Intraoperative Tourniquets in Upper Limb Surgery
J Wen, Z Lin, L Bommireddy- Surgery
Abstract
Background
New BOAST standards were published in October 2021, advocating the need for all tourniquet pressure to be inflated 50-100mmHg above the adult patient’s systolic blood pressure when undergoing upper limb surgeries. The aim was to assess whether conformity was present towards this standard.
Method
A closed-loop prospective audit was implemented in a specialist hand unit from October to December 2021. Readings, including blood pressure before tourniquet inflation, final inflation pressure, tourniquet time, and level of performing surgeon, were collected from documentation and analysed.
Results
A total of 100 patients were assessed. The initial audit and re-audit demonstrated low compliance levels of 36% (18/50) and 38% (19/42), respectively, despite specific educational interventions regarding the newly published standard. When comparing junior and specialist hand consultants, non-compliance was more significant at the more senior level (63.4%). All non-compliance was a result of the overinflation of the tourniquet. The average overinflation was 20.6mmHg, and the average tourniquet time was 40.9 minutes. No tourniquet complications were documented in any case.
Conclusions
The primary rationale resulting in the non-compliance from the experienced hand surgical team was that the increased risk of obscuring the operative field from bleeding, thus leading to structural damages, outweighs the complications of overinflating the tourniquet. Furthermore, systolic blood pressure cannot always be maintained within a restricted window from the anaesthetic perspective. Therefore, we propose that the guideline be opened for further discussion and more up-to-date research implemented in this field.