PMID- 32197253
OWN - NLM
STAT- Publisher
LR  - 20240227
IS  - 1547-5646 (Electronic)
IS  - 1547-5646 (Linking)
DP  - 2020 Mar 20
TI  - Cost-benefit analysis of tranexamic acid and blood transfusion in elective lumbar 
      spine surgery for degenerative pathologies.
PG  - 1-9
LID - 2020.1.SPINE191464 [pii]
LID - 10.3171/2020.1.SPINE191464 [doi]
AB  - OBJECTIVE: Blood transfusions are given to approximately one-fifth of patients 
      undergoing elective lumbar spine surgery, and previous studies have shown that 
      transfusions are accompanied by increased complications and additional costs. One 
      method for decreasing transfusions is administration of tranexamic acid (TXA). 
      The authors sought to evaluate whether the cost of TXA is offset by the decrease 
      in blood utilization in lumbar spine surgery patients. METHODS: The authors 
      retrospectively reviewed patients who underwent elective lumbar or thoracolumbar 
      surgery for degenerative conditions at a tertiary care center between 2016 and 
      2018. Patients who received intraoperative TXA (TXA patients) were matched with 
      patients who did not receive TXA (non-TXA patients) by age, sex, BMI, ASA 
      (American Society of Anesthesiologists) physical status class, and surgical 
      invasiveness score. Primary endpoints were intraoperative blood loss, number of 
      packed red blood cell (PRBC) units transfused, and total hemostasis costs, 
      defined as the sum of TXA costs and blood transfusion costs throughout the 
      hospital stay. A subanalysis was then performed by substratifying both cohorts 
      into short-length (1-4 levels) and long-length (5-8 levels) spinal constructs. 
      RESULTS: Of the 1353 patients who met inclusion criteria, 68 TXA patients were 
      matched to 68 non-TXA patients. Patients in the TXA group had significantly 
      decreased mean intraoperative blood loss (1039 vs 1437 mL, p = 0.01). There were 
      no differences between the patient groups in the total costs of blood transfusion 
      and TXA (p = 0.5). When the 2 patient groups were substratified by length of 
      construct, the long-length construct group showed a significant net cost savings 
      of $328.69 per patient in the TXA group (p = 0.027). This result was attributable 
      to the finding that patients undergoing long-length construct surgeries who were 
      given TXA received a lower amount of PRBC units throughout their hospital stay 
      (2.4 vs 4.0, p = 0.007). CONCLUSIONS: TXA use was associated with decreased 
      intraoperative blood loss and significant reductions in total hemostasis costs 
      for patients undergoing surgery on more than 4 levels. Furthermore, the use of 
      TXA in patients who received short constructs led to no additional net costs. 
      With the increasing emphasis put on value-based care interventions, use of TXA 
      may represent one mechanism for decreasing total care costs, particularly in the 
      cases of larger spine constructs.
FAU - Ehresman, Jeff
AU  - Ehresman J
AD  - Departments of1Neurosurgery and.
FAU - Pennington, Zach
AU  - Pennington Z
AD  - Departments of1Neurosurgery and.
FAU - Schilling, Andrew
AU  - Schilling A
AD  - Departments of1Neurosurgery and.
FAU - Medikonda, Ravi
AU  - Medikonda R
AD  - Departments of1Neurosurgery and.
FAU - Huq, Sakibul
AU  - Huq S
AD  - Departments of1Neurosurgery and.
FAU - Merkel, Kevin R
AU  - Merkel KR
AD  - 2Anesthesiology, Johns Hopkins School of Medicine; and.
FAU - Ahmed, A Karim
AU  - Ahmed AK
AD  - Departments of1Neurosurgery and.
FAU - Cottrill, Ethan
AU  - Cottrill E
AD  - Departments of1Neurosurgery and.
FAU - Lubelski, Daniel
AU  - Lubelski D
AD  - Departments of1Neurosurgery and.
FAU - Westbroek, Erick M
AU  - Westbroek EM
AD  - Departments of1Neurosurgery and.
FAU - Farrokh, Salia
AU  - Farrokh S
AD  - 3Department of Pharmacy, Division of Critical Care and Surgery Pharmacy, Johns 
      Hopkins Hospital, Baltimore, Maryland.
FAU - Frank, Steven M
AU  - Frank SM
AD  - 2Anesthesiology, Johns Hopkins School of Medicine; and.
FAU - Sciubba, Daniel M
AU  - Sciubba DM
AD  - Departments of1Neurosurgery and.
LA  - eng
PT  - Journal Article
DEP - 20200320
PL  - United States
TA  - J Neurosurg Spine
JT  - Journal of neurosurgery. Spine
JID - 101223545
SB  - IM
OTO - NOTNLM
OT  - ASA = American Society of Anesthesiologists
OT  - ASD = adult spinal deformity
OT  - ASD-S = adult spinal deformity-surgical
OT  - EACA = epsilon-aminocaproic acid
OT  - INR = international normalized ratio
OT  - MCV = mean corpuscular volume
OT  - PRBC = packed red blood cell
OT  - RCT = randomized controlled trial
OT  - TXA = tranexamic acid
OT  - aPTT = activated partial thromboplastin time
OT  - blood loss
OT  - cost
OT  - lumbar spine surgery
OT  - tranexamic acid
OT  - transfusion
EDAT- 2020/03/21 06:00
MHDA- 2020/03/21 06:00
CRDT- 2020/03/21 06:00
PHST- 2019/12/08 00:00 [received]
PHST- 2020/01/21 00:00 [accepted]
PHST- 2020/03/21 06:00 [pubmed]
PHST- 2020/03/21 06:00 [medline]
PHST- 2020/03/21 06:00 [entrez]
AID - 2020.1.SPINE191464 [pii]
AID - 10.3171/2020.1.SPINE191464 [doi]
PST - aheadofprint
SO  - J Neurosurg Spine. 2020 Mar 20:1-9. doi: 10.3171/2020.1.SPINE191464.