在腰骶部手术中使用局部外用氨甲环酸联合或不联合静脉注射氨甲环酸预防手术部位血肿：一项质量改进项目

Preventing Surgical Site Hematoma Using Topical with or Without Intravenous Tranexamic Acid in Lumbosacral Surgery: A Quality Improvement Project.

作者信息

McCabe Robert W, Tong Doris, Kelkar Prashant, Richards Boyd, Soo Teck-Mun

机构信息

Division of Neurosurgery, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, Michigan, USA.

出版信息

World Neurosurg. 2023 Sep;177:e44-e51. doi: 10.1016/j.wneu.2023.05.007. Epub 2023 May 9.

DOI:10.1016/j.wneu.2023.05.007

PMID:37169074

Abstract

BACKGROUND

Postoperative surgical site hematoma (SSH) following lumbosacral surgery carries significant morbidity and increased length of stay (LOS). Intravenous tranexamic acid (ivTXA) has been shown to reduce SSH rate. Topical TXA (tTXA) could benefit patients with contraindications to ivTXA. However, this has not been widely studied. We sought to demonstrate that a quality improvement (QI) protocol using tTXA with/without ivTXA in patients undergoing elective open and minimally invasive lumbosacral surgery could decrease the SSH rate and LOS with no increase in associated complications.

METHODS

A retrospective chart review for July 2018-June 2019 demonstrated our preimplementation baseline SSH rate. We conducted interdisciplinary meetings to develop standardized institutional measures and perioperative tTXA administration protocol. The primary outcome was SSH necessitating evacuation. The secondary outcome was LOS and TXA-related complications. The postimplementation data were collected prospectively from July 2020-October 2020. Univariate analysis was used to compare preimplementation and postimplementation cohorts. We considered a P-value <0.05 significant.

RESULTS

Comparing consecutive lumbosacral surgical patients in pre- (219 patients) and postimplementation (258 patients), the postimplementation group demonstrated a significantly reduced rate of SSH requiring evacuation (0.38% vs. 3.3%, P < 0.001), significantly increased tTXA utilization (86.0% vs. 9.6%, P < 0.001), significantly lower incidence of SSH in tTXA patients (0.45% vs. 4.8%, P = 0.037), and significantly decreased LOS (3.4 ± 2.5 vs. 3.1 ± 2.7, P = 0.003). There were no complications attributable to TXA use.

CONCLUSIONS

Our Quality Improvement (QI) project successfully increased compliance with the use of tTXA. Post-implementation rate of SSH requiring evacuation and LOS was significantly lowered with no associated complications.

摘要

背景

腰骶部手术后手术部位血肿（SSH）会带来严重的发病率并延长住院时间（LOS）。静脉注射氨甲环酸（ivTXA）已被证明可降低SSH发生率。局部应用氨甲环酸（tTXA）可能使有ivTXA禁忌证的患者受益。然而，这方面尚未得到广泛研究。我们试图证明，在接受择期开放性和微创腰骶部手术的患者中，使用tTXA联合/不联合ivTXA的质量改进（QI）方案可降低SSH发生率和住院时间，且不会增加相关并发症。

方法

对2018年7月至2019年6月进行回顾性病历审查，以确定我们实施前的SSH发生率基线。我们召开了跨学科会议，以制定标准化的机构措施和围手术期tTXA给药方案。主要结局是需要引流的SSH。次要结局是住院时间和与TXA相关的并发症。实施后的数据于2020年7月至2020年10月前瞻性收集。采用单因素分析比较实施前和实施后的队列。我们认为P值<0.05具有统计学意义。

结果

比较实施前（219例患者）和实施后（258例患者）连续的腰骶部手术患者，实施后组需要引流的SSH发生率显著降低（0.38%对3.3%，P<0.001），tTXA使用率显著提高（86.0%对9.6%，P<0.001），tTXA患者中SSH的发生率显著降低（0.45%对4.8%，P=0.037），住院时间显著缩短（3.4±2.5对3.1±2.7，P=0.003）。没有因使用TXA导致的并发症。