Neurosurgery Resident, PGY-5 University of Pennsylvania Philadelphia, Pennsylvania, United States
Introduction: Tranexamic acid (TXA) is commonly administered perioperatively to minimize blood loss during surgery for spine deformity correction. Debate persists regarding the safety of TXA due to its prothrombotic effects. We investigated the effects of intraoperative TXA administration in patients undergoing three column osteotomy (3CO) for deformity correction on length of stay (LOS), readmission, and reoperation rates.
Methods: Patients undergoing 3CO between 2014 and 2021 were identified using CPT codes, and charts were reviewed for demographics, surgical characteristics, and post-operative LOS. Statistical analysis included T tests for continuous characteristics and 2 testing for categorical characteristics. Linear regression models, including TXA use, age, operative length, and percent estimated blood volume loss with either ICU or Hospital LOS as the dependent variable were performed.
Results: 43 patients were identified, and 26 patients (60.5%) received TXA intraoperatively. There were no significant differences in body mass index (29.2 vs. 30.7, p=0.45), age (59.8 vs 63.0 years, p=0.34), length of surgery (9.8 vs 9.5 hours, p= 0.61), or percent estimated blood volume loss (47.8 vs. 41.0%, p= 0.28) between patients who received TXA and those who did not. There was a trend towards fewer blood transfusions in patients receiving TXA (3.7 vs. 2.4 units, p= 0.09). On univariate analysis, TXA administration was associated with significantly longer ICU (3.15 vs. 1.65 days, p=0.02) and Hospital LOS (10.12 vs. 6.06 days, p=0.003). There were no significant associations between TXA administration and readmission or reoperation at any time points. Linear regressions showed TXA use was associated with 4.1 day increase in hospital LOS (p= 0.006). TXA use was associated with a 2.2 day increase in ICU LOS, but this was no longer statistically significant (p=0.08) when controlling for the additional variables.
Conclusion : In patients undergoing 3CO, TXA use was associated with an increased hospital LOS and a trend towards increased ICU LOS. There were no statistically significant differences in intraoperative blood loss or blood transfusion between those who received TXA and those who did not. Future studies should investigate the drivers behind the observed increased LOS, including development of complications such as deep vein thrombosis or pulmonary embolism.
