Brett L Houston1,2, Dean A Fergusson3,4, Jamie Falk5, Robert Ariano5, Donald S Houston6, Emily Krupka7, Anna Blankstein8, Iris Perelman3, Rodney H Breau3,9, Daniel I McIsaac3,10, Emily Rimmer6, Allan Garland11, Alan Tinmouth3,4, Robert Balshaw12, Alexis F Turgeon13,14, Eric Jacobsohn15, Eric Bohm12,16, Ryan Zarychanski6,5,17. 1. Department of Medical Oncology and Haematology, CancerCare Manitoba and Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada. bhouston@cancercare.mb.ca. 2. College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada. bhouston@cancercare.mb.ca. 3. Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada. 4. Department of Medicine, University of Ottawa, Ottawa, ON, Canada. 5. College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada. 6. Department of Medical Oncology and Haematology, CancerCare Manitoba and Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada. 7. Faculty of Science, University of Manitoba, Winnipeg, MB, Canada. 8. Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada. 9. Department of Surgery, University of Ottawa, Ottawa, ON, Canada. 10. Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, ON, Canada. 11. Departments of Internal Medicine and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada. 12. George & Fay Yee Center for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, MB, Canada. 13. Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada. 14. CHU de Québec - Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Québec City, QC, Canada. 15. Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada. 16. Section of Orthopaedic Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada. 17. Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada.
Abstract
PURPOSE: Tranexamic acid (TXA) reduces red blood cell transfusion in various orthopedic surgeries, yet the degree of practice variation in its use among anesthesiologists and surgeons has not been described. To target future knowledge transfer and implementation strategies, and to better understand determinants of variability in prophylactic TXA use, our primary objective was to evaluate the influence of surgical team members on the variability of prophylactic TXA administration. METHODS: This was a retrospective cohort study of all adult patients undergoing primary total hip arthroplasty (THA), hip fracture surgery, and spine fusion ± vertebrectomy at two Canadian hospitals between January 2014 and December 2016. We used Canadian Classification of Health Interventions procedure codes within the Discharge Abstract Database which we linked to the Ottawa Data Warehouse. We described the percentage of patients that received TXA by individual surgery, the specifics of TXA dosing, and estimated the effect of anesthesiologists and surgeons on prophylactic TXA using multivariable mixed-effects logistic regression analyses. RESULTS: In the 3,900 patients studied, TXA was most commonly used in primary THA (85%; n = 1,344/1,582), with lower use in hip fracture (23%; n = 342/1,506) and spine fusion surgery (23%; n = 186/812). The median [interquartile range] total TXA dose was 1,000 [1,000-1,000] mg, given as a bolus in 92% of cases. Anesthesiologists and surgeons added significant variability to the odds of receiving TXA in hip fracture surgery and spine fusion, but not primary THA. Most of the variability in TXA use was attributed to patient and other factors. CONCLUSION: We confirmed the routine use of TXA in primary THA, while observing lower utilization with more variability in hip fracture and spine fusion surgery. Further study is warranted to understand variations in use and the barriers to TXA implementation in a broader population of orthopedic surgical patients at high risk for transfusion.
PURPOSE:Tranexamic acid (TXA) reduces red blood cell transfusion in various orthopedic surgeries, yet the degree of practice variation in its use among anesthesiologists and surgeons has not been described. To target future knowledge transfer and implementation strategies, and to better understand determinants of variability in prophylactic TXA use, our primary objective was to evaluate the influence of surgical team members on the variability of prophylactic TXA administration. METHODS: This was a retrospective cohort study of all adult patients undergoing primary total hip arthroplasty (THA), hip fracture surgery, and spine fusion ± vertebrectomy at two Canadian hospitals between January 2014 and December 2016. We used Canadian Classification of Health Interventions procedure codes within the Discharge Abstract Database which we linked to the Ottawa Data Warehouse. We described the percentage of patients that received TXA by individual surgery, the specifics of TXA dosing, and estimated the effect of anesthesiologists and surgeons on prophylactic TXA using multivariable mixed-effects logistic regression analyses. RESULTS: In the 3,900 patients studied, TXA was most commonly used in primary THA (85%; n = 1,344/1,582), with lower use in hip fracture (23%; n = 342/1,506) and spine fusion surgery (23%; n = 186/812). The median [interquartile range] total TXA dose was 1,000 [1,000-1,000] mg, given as a bolus in 92% of cases. Anesthesiologists and surgeons added significant variability to the odds of receiving TXA in hip fracture surgery and spine fusion, but not primary THA. Most of the variability in TXA use was attributed to patient and other factors. CONCLUSION: We confirmed the routine use of TXA in primary THA, while observing lower utilization with more variability in hip fracture and spine fusion surgery. Further study is warranted to understand variations in use and the barriers to TXA implementation in a broader population of orthopedic surgical patients at high risk for transfusion.
Authors: Molly A Feely; C Scott Collins; Paul R Daniels; Esayas B Kebede; Aminah Jatoi; Karen F Mauck Journal: Am Fam Physician Date: 2013-03-15 Impact factor: 3.292
Authors: Brett L Houston; Dean A Fergusson; Jamie Falk; Emily Krupka; Iris Perelman; Rodney H Breau; Daniel I McIsaac; Emily Rimmer; Donald S Houston; Allan Garland; Robert E Ariano; Alan Tinmouth; Robert Balshaw; Alexis F Turgeon; Eric Jacobsohn; Jason Park; Gordon Buduhan; Michael Johnson; Joshua Koulack; Ryan Zarychanski Journal: Transfus Med Rev Date: 2020-08-28
Authors: Jonas Alfitian; Max Joseph Scheyerer; Axel Rohde; Volker Schick; Tobias Kammerer; Robert Schier Journal: Arch Orthop Trauma Surg Date: 2022-06-16 Impact factor: 3.067