Clinical Effects of Intraoperative Use of Tranexamic Acid in Minimally Invasive Scoliosis Surgery for Adolescent Idiopathic Scoliosis

• Published in: Clinics in orthopedic surgery 2024, 16(6), , pp.941-947
• Main Authors: Lim, Jungwook, Kavishwar, Rohit Akshay, Shin, Joungwoo, Nam, Yunjin, Suh, Seung Woo, Yang, Jae Hyuk
• Format: Article
• Language: English
• Subjects: Adolescent; Antifibrinolytic Agents - administration & dosage; Antifibrinolytic Agents - therapeutic use; Blood Loss, Surgical - prevention & control; Blood Transfusion - statistics & numerical data; Child; Female; Humans; Intraoperative Care - methods; Male; Minimally Invasive Surgical Procedures - methods; Original; Retrospective Studies; Scoliosis - surgery; Tranexamic Acid - administration & dosage; Tranexamic Acid - therapeutic use; 정형외과학
• ISSN: 2005-291X; 2005-4408; 2005-4408
• DOI: 10.4055/cios24067

To evaluate the clinical impact of intraoperative tranexamic acid administration in minimizing intraoperative blood loss and transfusion requirements during minimally invasive scoliosis surgery (MISS). Consecutive data were collected from 97 patients with adolescent idiopathic scoliosis who underwent MISS between 2021 and 2023. Tranexamic acid was first introduced in June 2022. Surgical outcomes, complications, and blood parameters were compared between group A (no tranexamic acid) and group B (tranexamic acid). Forty-three patients underwent surgery without intraoperative tranexamic acid (group A), and 54 underwent surgery with tranexamic acid (group B). Variables including age, height, weight, body mass index, hospital stay duration, Cobb angle, correction rate, curve type, fusion extent, and pre- and postoperative hemoglobin levels were not significantly different between the 2 groups (all > 0.50). On average, 2.03 red blood cell (RBC) transfusions were administered. Group A required 2.6 units, whereas group B required 1.7 units, representing a significant reduction ( = 0.005). Postoperatively, an average of 0.5 RBC units were administered. Group A required 0.9 units, and group B required 0.3 units, with a significant difference ( = 0.001). No significant difference was found in the hemoglobin level between the day before surgery and postoperative days 1 and 4 (all > 0.05). Significant differences were observed between the 2 groups in the estimated blood loss change (1,358 vs. 1,118 mL, = 0.035) and Hemovac volume (1,063.26 vs. 910.65 mL, = 0.002). Eleven patients in group A required thoracentesis or chest tube insertion after MISS, whereas those in Group B did not require invasive procedures. In MISS, tranexamic acid reduced blood transfusion needs, Hemovac volume, incidence and severity of hemothorax, and pleural effusion were associated with thoracoplasty.