Genewoo J Hong1, Lauren A Wilson2, Jiabin Liu1, Stavros G Memtsoudis3. 1. Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY; Department of Anesthesiology, Weill Cornell Medical College, New York, NY. 2. Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY. 3. Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY; Department of Anesthesiology, Weill Cornell Medical College, New York, NY; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.
Abstract
BACKGROUND: Tranexamic acid (TXA) for the reduction of blood loss in orthopedic surgery is coming into greater adoption. Because TXA administration lowers the incidence of blood transfusion and of hematoma formation, risk factors for infection, we asked whether TXA use might be associated with a lower incidence of periprosthetic joint infection (PJI) following orthopedic surgery. METHODS: We queried the Premier Healthcare database for ICD-9 codes corresponding to elective inpatient primary total hip replacement (THR) or total knee replacement (TKR) from 2012 to 2016, TXA administration on the day of surgery, and PJI during the hospital stay or within 90 days. We performed a multilevel multivariable logistic regression (SAS version 9.4. SAS Institute, Cary, NC) to determine if TXA administration or other covariates were a significant predictor of infection. RESULTS: Among 914,990 total joint arthroplasty patients, 46.0% received TXA on the day of surgery. 0.13% developed PJI within 90 days. After adjusting for patient and hospital-related covariates, TXA use was associated with significantly lower odds of PJI within 90 days of surgery (OR 0.49 [0.69, 0.91]). CONCLUSION: Administration of TXA on the day of surgery in total knee and total hip arthroplasty was associated with a statistically significant decreased odds of PJI in the first 90 days. We therefore conclude that TXA might play an important role in our attempts to decrease PJI after joint arthroplasty. The exact mechanisms and ideal dosage by which TXA can contribute to such a reduction need further study.
BACKGROUND:Tranexamic acid (TXA) for the reduction of blood loss in orthopedic surgery is coming into greater adoption. Because TXA administration lowers the incidence of blood transfusion and of hematoma formation, risk factors for infection, we asked whether TXA use might be associated with a lower incidence of periprosthetic joint infection (PJI) following orthopedic surgery. METHODS: We queried the Premier Healthcare database for ICD-9 codes corresponding to elective inpatient primary total hip replacement (THR) or total knee replacement (TKR) from 2012 to 2016, TXA administration on the day of surgery, and PJI during the hospital stay or within 90 days. We performed a multilevel multivariable logistic regression (SAS version 9.4. SAS Institute, Cary, NC) to determine if TXA administration or other covariates were a significant predictor of infection. RESULTS: Among 914,990 total joint arthroplasty patients, 46.0% received TXA on the day of surgery. 0.13% developed PJI within 90 days. After adjusting for patient and hospital-related covariates, TXA use was associated with significantly lower odds of PJI within 90 days of surgery (OR 0.49 [0.69, 0.91]). CONCLUSION: Administration of TXA on the day of surgery in total knee and total hip arthroplasty was associated with a statistically significant decreased odds of PJI in the first 90 days. We therefore conclude that TXA might play an important role in our attempts to decrease PJI after joint arthroplasty. The exact mechanisms and ideal dosage by which TXA can contribute to such a reduction need further study.
Authors: Pier Francesco Indelli; F Iannotti; A Ferretti; R Valtanen; P Prati; D Pérez Prieto; N P Kort; B Violante; N R Tandogan; A Schiavone Panni; G Pipino; M T Hirschmann Journal: Knee Surg Sports Traumatol Arthrosc Date: 2021-09-13 Impact factor: 4.342
Authors: David A Kolin; Michael A Moverman; Mariano E Menendez; Nicholas R Pagani; Richard N Puzzitiello; Joseph J Kavolus Journal: J Orthop Date: 2021-07-13
Authors: Breanne H Y Gibson; Colby C Wollenman; Stephanie N Moore-Lotridge; Patrick R Keller; J Blair Summitt; Alexey R Revenko; Matthew J Flick; Timothy S Blackwell; Jonathan G Schoenecker Journal: JCI Insight Date: 2021-12-08