High Variability in Arthroscopic Fluid Use Among Surgeons and Joints for Common Orthopaedic Procedures

To determine arthroscopic fluid volume use patterns across common elective orthopaedic procedures, evaluate intersurgeon consistency in fluid use, and assess whether blood loss reduction adjuncts affect fluid consumption to generate actionable insights to guide surgeons in optimizing resource use, reducing waste, and improving efficiency during times of resource constraint.

A cross-sectional analysis at a single outpatient surgery center of adult arthroscopic procedures was conducted. A representative sample of 500 arthroscopic cases of the shoulder, elbow, knee, and ankle performed by multiple surgeons were reviewed. A total of 449 cases met inclusion criteria. Analysis of fluid use relative to body area, Current Procedural Terminology codes, surgeon, and blood loss reduction adjuncts (tranexamic acid [TXA] and epinephrine) was performed using analysis of variance tests.

Mean fluid volume was greatest in shoulder arthroscopy (16,582 ± 7,026 mL), followed by knee (8,677 ± 7,027 mL), elbow (6,489 ± 2,540 mL), and ankle procedures (3,534 ± 1,500 mL). Significant intersurgeon variation was observed (F = 19.61, P = .0001). Epinephrine was used in 58.8% of cases, with mean fluid volume of 11,571 ± 6,896 mL for local injection and 15,401 ± 8,610 mL for arthroscopic fluid administration. Cases without epinephrine averaged 7,676 ± 6,570 mL of fluid use. TXA was used in only 0.7% of cases. Neither epinephrine nor TXA showed significant reduction in fluid consumption (P > .05).

Arthroscopic fluid use across anatomic regions was highly varied, with shoulder procedures requiring the greatest volumes. Surgeon-specific use patterns also varied considerably. The use of neither TXA nor epinephrine reduced fluid consumption, although this finding may reflect the small sample size and lack of standardized protocols rather than true ineffectiveness.

Level III, cross-sectional study.