Abstract
Tranexamic acid (TXA) reduces blood loss and transfusion rates in unilateral total knee arthroplasty (TKA), but there is limited data regarding its efficacy in bilateral TKA. This study reports the impact TXA has on clinical outcomes and hospital cost of care in simultaneous, primary bilateral TKA. The 449 patients were retrospectively reviewed. Primary outcomes included the rates of allogeneic and autologous blood transfusion. Secondary outcomes included hospital length of stay (HLOS), post-hospital discharge disposition, 30-day thromboembolic events (TEE), and mean hospital cost of care. Total direct medical costs were obtained from an institutional research database and adjusted to nationally representative unit costs in 2013 inflation-adjusted dollars. Our study revealed that in patients undergoing simultaneous bilateral TKA, TXA use was associated with reduced allogeneic (OR 0.181, 95% CI 0.090-0.366, p < 0.001) and combined allogeneic and autologous transfusion rates (OR 0.451, 95% CI 0.235-0.865, p = 0.017). TXA was associated with a HLOS reduction of 0.9 days (β-coefficient −0.582, 95% CI −1.008-−0.156, p = 0.008), an increased likelihood of hospital discharge over skilled nursing facility (SNF) (OR 2.25, 95% CI 1.117-4.531, p = 0.023) and reduced total hospital cost of care by 6.45% (p < 0.001), room and board costs by 11.76% (p < 0.001), and transfusion costs by 81.65% (p < 0.001). In conclusion, TXA use in bilateral TKA is associated with lower blood transfusion rates, reduced hospital length of stay, reduced cost of hospital care and skilled nursing facility avoidance.
Highlights
Numerous trials and meta-analyses have demonstrated that tranexamic acid (TXA) use decreases blood loss, transfusion rate, and cost of care in patients undergoing total knee arthroplasty (TKA) [1,2,3,4,5,6,7,8]
The patient populations were similar with the exception of age, history of deep vein thrombosis (DVT), and history of cerebrovascular accident (CVA)
TXA was associated with a significant reduction in the rate of allogeneic and combined allogeneic and autologous transfusion
Summary
Numerous trials and meta-analyses have demonstrated that tranexamic acid (TXA) use decreases blood loss, transfusion rate, and cost of care in patients undergoing total knee arthroplasty (TKA) [1,2,3,4,5,6,7,8]. Hospital length of stay (HLOS) appears to be a dominant factor in TKA costs. Few studies have examined the impact of TXA on the clinical outcomes, HLOS, post-hospital disposition, and total cost of care in patients undergoing bilateral TKA [9,10,11,12,13]. Most investigations on TXA administration in bilateral TKA are of limited sample size and are focused. Submitted: 14 August 2020/Accepted: 21 October 2020
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