Department of Orthopaedic Surgery, Vanderbilt University Medical Center.
Vanderbilt University, School of Medicine.
Clin Spine Surg. 2024 Feb 1;37(1):E18-E23. doi: 10.1097/BSD.0000000000001508. Epub 2023 Aug 3.
Retrospective cohort study using prospectively collected data.
To determine the effectiveness of intraoperative tranexamic acid (TXA) in anterior cervical discectomy and fusion (ACDF) on postoperative blood loss.
TXA has been proven to be a safe and effective agent in reducing blood loss after cervical surgery; however, its efficacy when used intraoperatively for ACDF surgeries had yet to be researched. Currently, there are few studies examining the effects of intraoperative TXA in cervical spinal fusion, and none specifically examining TXA use in ACDF.
A tertiary medical center's prospectively collected spine registry was queried between 1/1/18 and 12/1/21 for all patients who underwent elective ACDF surgery and received a drain postoperatively. Patients were separated into 2 groups; those who had received intraoperative TXA and those who did not. Baseline demographic and operative variables were collected from the registry. The primary outcome was postoperative blood loss over a 24-hour period. Secondary outcomes included total drain output, intraoperative estimated blood loss, operative duration, drain duration, changes in preoperative to postoperative hemoglobin and hematocrit levels, and rate of transfusions, complications, revisions, and reoperations. Univariate and multivariate regression analyses were performed.
Two hundred eighty-six patients were included. One hundred ninety patients underwent ACDF and did not receive intraoperative TXA, whereas 96 patients underwent ACDF and did receive TXA. There were no differences in any demographic or baseline variables. Multivariate analysis showed intraoperative TXA was associated with shorter drain duration (β=-5.74, 95% CI: -10.9 to -0.53, P =0.031) and reduction in 24-hour drain output (β=-12.2, 95% CI: -19.4 to -4.89, P =0.001) and total drain output (β=-14.0, 95% CI: -22.9 to -5.05, P =0.002).
TXA use during ACDF procedures leads to a decrease in perioperative blood loss and faster drain removal. TXA is an effective and safe agent for reducing perioperative blood loss in ACDF surgery.
III.
回顾性队列研究，使用前瞻性收集的数据。
确定术中氨甲环酸（TXA）在前路颈椎间盘切除融合术（ACDF）中对术后出血量的有效性。
TXA 已被证明是一种安全有效的减少颈椎手术后失血的药物；然而，其在 ACDF 手术中术中使用的效果尚未得到研究。目前，很少有研究检查术中 TXA 在颈椎融合术中的影响，也没有专门研究 TXA 在 ACDF 中的使用。
对 2018 年 1 月 1 日至 2021 年 12 月 1 日期间在一家三级医疗中心前瞻性收集的脊柱登记处进行查询，以获取所有接受择期 ACDF 手术并在术后放置引流管的患者。患者分为两组；一组接受术中 TXA，另一组未接受。从登记处收集基线人口统计学和手术变量。主要结果是 24 小时内的术后失血量。次要结果包括总引流量、术中估计失血量、手术时间、引流时间、术前至术后血红蛋白和血细胞比容水平的变化以及输血率、并发症、翻修和再次手术。进行了单变量和多变量回归分析。
共纳入 286 例患者。190 例患者接受 ACDF 且未接受术中 TXA，96 例患者接受 ACDF 且接受 TXA。两组在任何人口统计学或基线变量上均无差异。多变量分析显示，术中 TXA 与引流管留置时间缩短（β=-5.74，95%CI：-10.9 至-0.53，P=0.031）和 24 小时引流量减少（β=-12.2，95%CI：-19.4 至-4.89，P=0.001）和总引流量减少（β=-14.0，95%CI：-22.9 至-5.05，P=0.002）相关。
ACDF 手术中使用 TXA 可减少围手术期失血并加快引流管移除。TXA 是减少 ACDF 手术围手术期失血的有效且安全的药物。
III 级。
