McGoldrick Niall P, O'Connor Eabhann M, Davarinos Nikos, Galvin Rose, Quinlan John F
Niall P McGoldrick, Eabhann M O'Connor, Nikos Davarinos, John F Quinlan, Department of Trauma and Orthopaedic Surgery, Tallaght Hospital, Dublin D24 NR0A, Ireland.
World J Orthop. 2015 Dec 18;6(11):977-82. doi: 10.5312/wjo.v6.i11.977.
To examine the cost benefit conferred by the perioperative administration of intravenous tranexamic acid (TXA) in lower limb arthroplasty.
This study evaluates the use of TXA in 200 consecutive lower limb arthroplasties performed in a single surgeon series. The initial 100 patients (control group) underwent surgery without perioperative administration of TXA while the subsequent 100 patients (TXA group) all received 1 g TXA at the time of induction of anaesthesia. Pre- and post-operative haemoglobin, platelet count, haematocrit, the use of blood product post-operatively, length of stay were examined. A financial analysis of both groups was then undertaken.
The mean age of patients in both groups was 63 ± 13 years. There were no significant differences between groups in terms of gender (P = 0.47), proportion of total hip replacement to total knee replacement (P = 0.25) or pre-operative haemoglobin (P = 0.43). In the control group, the transfusion rate was 22%. In the TXA group, the transfusion rate dropped to 2% (P < 0.001). The mean post-operative haemoglobin was 10.82 ± 1.55 g/dL in the control group vs 11.33 ± 1.27 g/dL in the TXA group (P = 0.01). The total cost of transfused blood products was €11055 and €603 respectively. The mean length of stay in the control group was 6.53 ± 5.93 d vs 5.47 ± 4.26 d in the TXA group (P = 0.15) leading to an estimated financial saving of €114586. There was one pulmonary embolus in the control group and one deep venous thrombosis in the TXA group.
Intravenous TXA reduces blood loss in lower limb arthroplasty. This leads to lower transfusion rates, shorter length of stay in hospital and significant financial savings.
探讨下肢关节置换术中静脉注射氨甲环酸（TXA）的围手术期应用所带来的成本效益。
本研究评估了在一位外科医生所做的连续200例下肢关节置换术中TXA的使用情况。最初的100例患者（对照组）在手术期间未接受TXA静脉注射，而随后的100例患者（TXA组）在麻醉诱导时均接受了1克TXA。检测术前和术后的血红蛋白、血小板计数、血细胞比容、术后血液制品的使用情况以及住院时间。然后对两组进行了财务分析。
两组患者的平均年龄均为63±13岁。两组在性别（P = 0.47）、全髋关节置换与全膝关节置换的比例（P = 0.25）或术前血红蛋白水平（P = 0.43）方面无显著差异。对照组的输血率为22%。在TXA组，输血率降至2%（P < 0.001）。对照组术后平均血红蛋白水平为10.82±1.55克/分升，而TXA组为11.33±1.27克/分升（P = 0.01）。输血用血液制品的总成本分别为11055欧元和603欧元。对照组的平均住院时间为6.53±5.93天，而TXA组为5.47±4.26天（P = 0.15），估计节省财务成本114586欧元。对照组发生1例肺栓塞，TXA组发生1例深静脉血栓形成。
静脉注射TXA可减少下肢关节置换术中的失血。这导致输血率降低、住院时间缩短并节省大量财务成本。
