肩关节炎置换术中氨甲环酸的应用及真实世界疗效：一项基于人群的研究。
Utilization and Real-world Effectiveness of Tranexamic Use in Shoulder Arthroplasty: A Population-based Study.
机构信息
From the Department of Orthopaedic Surgery (Dr. Anthony, Dr. Patterson, Dr. Cagle, and Dr. Galatz), Icahn School of Medicine at Mount Sinai Health System, and the Institute for Healthcare Delivery Science (Dr. Poeran, Ms. Zubizarreta, and Dr. Mazumdar), the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai Health System, New York, NY.
出版信息
J Am Acad Orthop Surg. 2019 Oct 1;27(19):736-742. doi: 10.5435/JAAOS-D-18-00206.
INTRODUCTION
Tranexamic acid (TXA) is increasingly used to reduce blood loss in lower extremity arthroplasty, but limited data exist for its effectiveness in patients undergoing shoulder arthroplasty. We aimed to use national data to assess the frequency of use and effectiveness of TXA in patients undergoing shoulder arthroplasty.
METHODS
Using national claims data from patients undergoing shoulder arthroplasty (Premier Healthcare; 2010 to 2016; n = 82,512; 429 hospitals), we categorized patients according to whether they received perioperative TXA. Multilevel multivariable regression models measured associations between TXA and blood transfusion risk, combined complications (including thromboembolic events, acute renal failure, cerebral infarction, and acute myocardial infarction), and length and cost of hospitalization. Odds ratios (ORs) and 95% confidence intervals (CIs) are reported.
RESULTS
Overall, TXA was used in 12.8% (n = 10,582) of patients with a strong increasing trend. After adjustment for relevant covariates, TXA use (compared with no TXA use) was associated with a 36% decrease in transfusion risk (OR, 0.64; 95% CI, 0.52 to 0.77; P < 0.05) and a 35% decreased risk for combined complications (OR, 0.65; 95% CI, 0.50 to 0.83; P < 0.05). Moreover, TXA use was associated with 6.2% shorter hospital stay (95% CI, -8.0% to -4.4%; P < 0.05), whereas no difference was observed with the cost of hospitalization.
CONCLUSION
In this first large-scale study assessing TXA use and effectiveness in patients undergoing shoulder arthroplasty, we found that although TXA utilization is still low, it is associated with a marked decrease in transfusion risk with no increases in complication risk. Effects on the length and cost of hospitalization appeared minor. Future studies should assess whether higher volumes of TXA utilization would translate into more gains on the length and cost of hospitalization.
LEVEL OF EVIDENCE
Level III.
简介
氨甲环酸（TXA）在下肢关节置换术中越来越多地被用于减少失血，但在肩关节置换术中其有效性的数据有限。我们旨在利用全国性数据评估 TXA 在肩关节置换术中的使用频率和效果。
方法
我们使用来自 Premier Healthcare 的全国性肩关节置换术患者（2010 年至 2016 年；n=82512；429 家医院）的数据，根据患者是否接受围手术期 TXA 治疗将患者分类。多水平多变量回归模型测量了 TXA 与输血风险、联合并发症（包括血栓栓塞事件、急性肾衰竭、脑梗死和急性心肌梗死）以及住院时间和费用之间的关联。报告比值比（OR）和 95%置信区间（CI）。
结果
总体而言，12.8%（n=10582）的患者使用了 TXA，且呈明显上升趋势。在调整了相关协变量后，与未使用 TXA 相比，使用 TXA 与输血风险降低 36%（OR，0.64；95%CI，0.52 至 0.77；P<0.05）和联合并发症风险降低 35%（OR，0.65；95%CI，0.50 至 0.83；P<0.05）相关。此外，TXA 治疗与住院时间缩短 6.2%（95%CI，-8.0%至-4.4%；P<0.05）相关，而住院费用无差异。
结论
在这项评估肩关节置换术中 TXA 使用和效果的首次大规模研究中，我们发现尽管 TXA 的使用率仍然较低，但它与输血风险的显著降低相关，而不增加并发症风险。对住院时间和费用的影响似乎较小。未来的研究应评估更高剂量的 TXA 使用率是否会转化为住院时间和费用的更长和更高的获益。
证据等级
三级。
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