Tranexamic Acid is Associated with Reduced Blood Loss and Transfusion Requirement in Pediatric Midface Reconstruction

Abstract

BackgroundMidface reconstruction poses challenges due to significant blood loss and difficulty in achieving intraoperative hemostasis, often necessitating blood transfusions. Various agents, most notably tranexamic acid (TXA), have been utilized intraoperatively to mitigate this risk of bleeding and transfusion-related complications. PurposeThe study purpose was to measure the association of TXA with blood loss and transfusion requirements during craniofacial procedures involving the midface. Study design, setting, sampleThis project was designed as a retrospective cohort study. Patients who underwent midface reconstruction at Children's Hospital Los Angeles (CHLA) between 2010 and 2023 were included, and a retrospective chart review was conducted. Independent variableThe independent variable was weight-adjusted TXA exposure divided into two groups: subjects who received TXA pre- and intraoperatively and those that did not. Main Outcome VariablesThe main outcome variables were weight-adjusted intraoperative blood loss and transfusion requirements. Secondary outcomes included intra- and postoperative complications and length of stay. CovariatesDemographic covariates included age at surgery, sex, weight, and syndromic status. Operative covariates covered the type of surgical approach and main procedure performed. Perioperative covariates included anesthesia time and operative time. AnalysesParametric and non-parametric variables were analyzed using independent t-test and Wilcoxon rank-sum test, respectively. Chi-squared analysis was used to analyze categorical variables, and multivariable linear regressions were performed. A p-value of less than 0.05 was considered statistically significant. ResultsA total of 80 patients underwent midface reconstruction surgery, 37 (46.3%) of whom received TXA and 43(53.7%) did not. The mean age at surgery was 8.7±3.8 years in the TXA cohort and 11.6±5.1 years in the non-TXA cohort (p=0.02). Multivariable regression analysis further demonstrated a statistically significant association between the administration of TXA and both reduced blood loss (coefficient -0.14 [95% CI -0.20 to -0.07], p<0.01) as well as reduced transfusion requirement (coefficient -0.14 [95% CI -0.19 to -0.08], p<0.01). There was no increased risk of complications, such as thromboembolic events or seizures, in patients who were administered TXA (p=0.14). Conclusion and RelevanceTXA is likely a valuable adjunct for improving intra- and postoperative outcomes of craniofacial procedures involving the midface.