Department of Medical Oncology and Haematology, CancerCare Manitoba and Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada.
Can J Anaesth. 2021 Jul;68(7):962-971. doi: 10.1007/s12630-021-01939-x. Epub 2021 Feb 16.
Tranexamic acid (TXA) reduces red blood cell transfusion in various orthopedic surgeries, yet the degree of practice variation in its use among anesthesiologists and surgeons has not been described. To target future knowledge transfer and implementation strategies, and to better understand determinants of variability in prophylactic TXA use, our primary objective was to evaluate the influence of surgical team members on the variability of prophylactic TXA administration.
This was a retrospective cohort study of all adult patients undergoing primary total hip arthroplasty (THA), hip fracture surgery, and spine fusion ± vertebrectomy at two Canadian hospitals between January 2014 and December 2016. We used Canadian Classification of Health Interventions procedure codes within the Discharge Abstract Database which we linked to the Ottawa Data Warehouse. We described the percentage of patients that received TXA by individual surgery, the specifics of TXA dosing, and estimated the effect of anesthesiologists and surgeons on prophylactic TXA using multivariable mixed-effects logistic regression analyses.
In the 3,900 patients studied, TXA was most commonly used in primary THA (85%; n = 1,344/1,582), with lower use in hip fracture (23%; n = 342/1,506) and spine fusion surgery (23%; n = 186/812). The median [interquartile range] total TXA dose was 1,000 [1,000-1,000] mg, given as a bolus in 92% of cases. Anesthesiologists and surgeons added significant variability to the odds of receiving TXA in hip fracture surgery and spine fusion, but not primary THA. Most of the variability in TXA use was attributed to patient and other factors.
We confirmed the routine use of TXA in primary THA, while observing lower utilization with more variability in hip fracture and spine fusion surgery. Further study is warranted to understand variations in use and the barriers to TXA implementation in a broader population of orthopedic surgical patients at high risk for transfusion.
氨甲环酸（TXA）可减少各种骨科手术中的红细胞输血，但麻醉师和外科医生在使用 TXA 方面的实践差异程度尚未描述。为了确定未来的知识转移和实施策略，并更好地了解预防性 TXA 使用变异性的决定因素，我们的主要目标是评估手术团队成员对预防性 TXA 给药变异性的影响。
这是一项回顾性队列研究，纳入了 2014 年 1 月至 2016 年 12 月在加拿大两家医院接受初次全髋关节置换术（THA）、髋部骨折手术和脊柱融合术+椎体切除术的所有成年患者。我们在出院摘要数据库中使用加拿大卫生干预分类程序代码，并将其链接到渥太华数据仓库。我们描述了每位患者接受 TXA 的百分比、TXA 剂量的具体情况，并使用多变量混合效应逻辑回归分析估计了麻醉师和外科医生对预防性 TXA 的影响。
在 3900 名研究患者中，TXA 最常用于初次 THA（85%；n=1344/1582），髋部骨折（23%；n=342/1506）和脊柱融合手术（23%；n=186/812）中使用较少。TXA 的中位[四分位间距]总剂量为 1000[1000-1000]mg，92%的病例给予推注。麻醉师和外科医生在髋部骨折手术和脊柱融合术中使接受 TXA 的可能性增加了显著的变异性，但在初次 THA 中则没有。TXA 使用的大部分变异性归因于患者和其他因素。
我们证实了 TXA 在初次 THA 中的常规使用，同时观察到在髋部骨折和脊柱融合手术中使用较少，变异性更大。需要进一步研究以了解在更广泛的骨科手术患者中 TXA 的使用差异以及在输血风险较高的患者中实施 TXA 的障碍。
