Physician Learning Program, Continuing Medical Education and Professional Development, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Department of Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Can J Anaesth. 2022 Sep;69(9):1129-1138. doi: 10.1007/s12630-022-02236-x. Epub 2022 Jul 25.
Intraoperative tranexamic acid (TXA) is used to reduce blood loss and the need for transfusions following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Despite evidence in literature and local practice protocols supporting TXA as a part of standard of care for joint arthroplasty, TXA administration is underutilized. We aimed to use group-facilitated audit and feedback as the foundation of a knowledge translation strategy to increase TXA use for THA and TKA procedures.
Anesthesiologists consented to receive two data reports summarizing their individual rates of TXA use and postoperative blood transfusions compared with site peers. Variables collected included patient demographics, TXA usage, and the frequency and volume of red blood cell transfusions administered in the 72-hr postoperative period. The facilitated feedback session discussed report findings and focused on factors contributing to local practice patterns and opportunities for change.
Tranexamic acid use increased for THA procedures at the intervention site from 66.6 to 74.4% (absolute change, 7.9%; 95% confidence interval [CI], 2.4 to 13.3). Likewise, TXA use for TKA procedures increased from 62.4 to 82.3% (absolute change, 19.9%; 95% CI 15.0 to 25.0).
Physicians and their teams were able to review their practice data on TXA utilization, reflect on differences compared with evidence-based guidelines, discuss findings with peers, and identify opportunities for improvement. The intervention increased the use of TXA for both TKA and THA and shifted the dosage to better align with evidence-based practice guidelines.
氨甲环酸（TXA）在全髋关节置换术（THA）和全膝关节置换术（TKA）后被用于减少失血和输血需求。尽管文献中有证据和当地实践方案支持 TXA 作为关节置换术标准护理的一部分，但 TXA 的使用仍未得到充分利用。我们旨在使用小组促进的审核和反馈作为知识转化策略的基础，以增加 THA 和 TKA 手术中 TXA 的使用。
麻醉师同意接收两份数据报告，总结他们个人的 TXA 使用率和术后输血率与现场同行进行比较。收集的变量包括患者人口统计学特征、TXA 使用情况以及术后 72 小时内给予的红细胞输血的频率和体积。促进反馈会议讨论了报告结果，并重点讨论了影响当地实践模式的因素以及改变的机会。
干预现场的 THA 手术中 TXA 的使用从 66.6%增加到 74.4%（绝对变化 7.9%；95%置信区间 [CI] 2.4 至 13.3）。同样，TKA 手术中 TXA 的使用从 62.4%增加到 82.3%（绝对变化 19.9%；95%CI 15.0 至 25.0）。
医生及其团队能够审查他们关于 TXA 利用的实践数据，反思与基于证据的指南的差异，与同行讨论发现，并确定改进的机会。干预措施增加了 TKA 和 THA 中 TXA 的使用，并将剂量调整至更符合基于证据的实践指南。
