Second Place Award: Tranexamic acid and intrathecal morphine are synergistic in reducing transfusion requirements in pediatric posterior spinal fusion

Abstract

Background: Previous studies demonstrated that the independent use of both tranexamic acid (TXA) and intrathecal morphine (ITM) reduced transfusion requirements in scoliosis patients undergoing posterior spinal fusion (PSF). This study examined the combined effects of TXA and ITM on transfusion requirements in pediatric patients undergoing PSF. Methods: A retrospective review of consecutive patients treated with PSF at a single institution was performed. Patients with a minimum of 10 vertebral levels of fusion and PSF with segmental instrumentation were included. Transfusion records were reviewed during surgery and 7 days postoperatively. Patients were divided into four treatment groups for comparison: 1. No TXA, No ITM; 2. Only TXA; 3. Only ITM and 4. TXA and ITM. Multivariate regression analysis, Student t-test, and chi-squared test were used to determine significance. Results: Five hundred and ninety-four patients met inclusion criteria; 63% (376/594) were female, average age: 14.6 yr (range 8.0-24.3 yr) and average 13 levels fused (10-18 levels). Fifty-three percent (316/594) received packed red blood cell (PRBC) transfusion. Patients receiving the TXA and ITM combination had 72% lower odds ratio of transfusion (P<0.001, OR 0.28, CI 0.14-0.56). Patients did not have lower odds ratio of transfusion when receiving TXA alone (P=0.32, OR 0.65, CI 0.28-1.53) or ITM alone (P=0.09, OR 0.55, CI 0.28-1.09). Similar results were seen when patients were analyzed separately by diagnosis (idiopathic vs. nonidiopathic). Conclusions: The combination of TXA and ITM was associated with 72% reduction in odds ratio of PRBC transfusion in pediatric patients undergoing PSF, an effect seen in both idiopathic and nonidiopathic scoliosis when analyzed separately.