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Dai Z, Feng DP, Wu KL, Zhu JY, Li ZW. Hidden blood loss of minimally invasive hybrid lumbar interbody fusion: an analysis of influencing factors. BMC Musculoskelet Disord 2022; 23:1099. [PMID: 36522729 PMCID: PMC9753421 DOI: 10.1186/s12891-022-06079-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Lumbar interbody fusion(LIF) is the leading way to treat Lumbar Degenerative Diseases(LDD). At present, there is a lack of research on the influencing factors of hidden blood loss in minimally invasive hybrid lumbar interbody fusion. This study comprehensively explores the definite factors affecting the hidden blood loss in minimally invasive hybrid lumbar interbody fusion. MATERIALS AND METHODS One hundred patients with Lumbar degenerative diseases who underwent minimally invasive hybrid lumbar interbody fusion in our center were included. Demographics, laboratory data, surgical data, and radiographic data were collected. The Gross equation and Sehat equation were used to calculate the estimated value of hidden blood loss. Multi-factor linear regression analysis was used to determine the influencing factors of hidden blood loss. RESULT We reviewed and collected 100 patients who underwent minimally invasive hybrid approach, mean age 65 ± 10 years, male: female 37:63; 17 patients of diabetes and 83 patients of non-diabetes; Total blood loss was 645.59 ± 376.37 ml, hidden blood loss was 421.39 ± 337.45 ml, the hidden blood loss percentage was 57 ± 26%. Results from the multi-factorial linear regression model: Diabetes (p < 0.05), hypertension (p < 0.05), psoas thickness (p < 0.05) and dorsal extensor group thickness (p < 0.05) were potential risk factors for postoperative hidden blood loss. CONCLUSION Although minimally invasive hybrid approach is minimally invasive surgery, there is still a significant amount of hidden blood loss. There is a greater risk of blood loss in diabetes, hypertension and preoperative MRI assessment of thickness of the psoas, thickness of the dorsal extensor group.
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Affiliation(s)
- Zhong Dai
- grid.411971.b0000 0000 9558 1426The Second Affliated Hospital of Dalian Medical University, 467# ZhongShan Road, Dalian, Liaoning Province People’s Republic of China
| | - Da Peng Feng
- grid.411971.b0000 0000 9558 1426The Second Affliated Hospital of Dalian Medical University, 467# ZhongShan Road, Dalian, Liaoning Province People’s Republic of China
| | - Kang Long Wu
- grid.411971.b0000 0000 9558 1426The Second Affliated Hospital of Dalian Medical University, 467# ZhongShan Road, Dalian, Liaoning Province People’s Republic of China
| | - Jie Yang Zhu
- grid.411971.b0000 0000 9558 1426The Second Affliated Hospital of Dalian Medical University, 467# ZhongShan Road, Dalian, Liaoning Province People’s Republic of China
| | - Zheng Wei Li
- grid.411971.b0000 0000 9558 1426The Second Affliated Hospital of Dalian Medical University, 467# ZhongShan Road, Dalian, Liaoning Province People’s Republic of China
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Li TQ, Zhang X, Ma TC, Ma ZS. On Patient Safety: Concerns About Topical Tranexamic Acid in Spine Surgery. Clin Orthop Relat Res 2022; 480:2105-2107. [PMID: 36170170 PMCID: PMC9555923 DOI: 10.1097/corr.0000000000002428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Tian-qing Li
- Department of Orthopaedics, Xijing Hospital, the Air Force Medical University, Xincheng District, Xi’an City, Shaanxi Province, P.R. China
| | - Xu Zhang
- Department of Hand Surgery, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, P.R. China
| | - Tian-cheng Ma
- Department of Orthopaedics, Xijing Hospital, the Air Force Medical University, Xincheng District, Xi’an City, Shaanxi Province, P.R. China
| | - Zhen-sheng Ma
- Department of Orthopaedics, Xijing Hospital, the Air Force Medical University, Xincheng District, Xi’an City, Shaanxi Province, P.R. China
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Lei T, Bingtao W, Zhaoqing G, Zhongqiang C, Xin L. The efficacy and safety of intravenous tranexamic acid in patients with posterior operation of multilevel thoracic spine stenosis: a prospective randomized controlled trial. BMC Musculoskelet Disord 2022; 23:410. [PMID: 35501751 PMCID: PMC9063045 DOI: 10.1186/s12891-022-05361-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/25/2022] [Indexed: 01/11/2023] Open
Abstract
Background This study was a randomized controlled trial to evaluate efficacy and safety of the usage of intravenous tranexamic acid during posterior operation of multilevel thoracic spine stenosis for controlling perioperative blood loss. Methods Sixty eight patients with multilevel thoracic spine stenosis were randomized into the tranexamic acid group receiving 15 mg/kg body weight before the skin incision was made and 1 mg/kg body weight per hour during operation or the control group receiving the same dose of placebo (0.9% sodium chloride solution) intravenously. Pedicle screw fixation, laminectomy and selective discectomy were performed. Intraoperative and perioperative total blood loss were compared. The necessity and amount for blood transfusion, blood coagulation function, durations of postoperative hospital stays were compared. The complications of tranexamic acid were also investigated such as cardiovascular and cerebrovascular events, lower limb venous thrombosis. Results There were no statistically significant differences in age, gender, body mass index, ASA status, pathology required surgery, preoperative hemoglobin, operation time, laminectomy segments and discectomy segments between the tranexamic acid and control groups. The intraoperative blood loss (455.9 ± 206.6 ml vs 580.6 ± 224.3 ml, p < 0.05) and total blood loss (675.3 ± 170.3 ml vs 936.8 ± 306.4 ml, p < 0.01) in tranexamic acid group were significant lower than those in control group. The means of blood unit transfused (2.5 ± 1.0 vs 4.7 ± 2.4, p < 0.05) and Hb reduction in 48 h (22.5 ± 3.4 g/L vs 25.3 ± 3.9 g/L, p < 0.01) were significantly lower in tranexamic acid group than that in control group. There were no statistically significant differences in blood coagulation function pre-operation or 48 h post-operation between the tranexamic acid and the control groups. The requirements for patients to receive blood transfusion were fewer and durations of post-operational hospital stays were shorter in the tranexamic acid group, however, the difference did not achieve statistical significance. There was no significant difference in superficial or deep venous thrombosis of lower limbs or deterioration of neurological function between tranexamic acid group and control group. Conclusions Application of intravenous tranexamic acid significantly reduces intraoperative and perioperative total blood loss without significant side effects in posterior operation of multilevel thoracic spine stenosis. Trial registration At Chinese Clinal Trial Registry. http://www.chictr.org.cn/, ChiCTR2100054221. Registered on 11/12/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05361-2.
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Affiliation(s)
- Tan Lei
- Department of Orthopaedics, Peking University International Hospital, Life Park Road No 1 Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China
| | - Wen Bingtao
- Department of Orthopaedics, Peking University International Hospital, Life Park Road No 1 Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China
| | - Guo Zhaoqing
- Department of Orthopaedics, Peking University International Hospital, Life Park Road No 1 Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China
| | - Chen Zhongqiang
- Department of Orthopaedics, Peking University International Hospital, Life Park Road No 1 Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China
| | - Liu Xin
- Department of Orthopaedics, Peking University International Hospital, Life Park Road No 1 Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China.
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Perioperative Care of Patients Undergoing Major Complex Spinal Instrumentation Surgery: Clinical Practice Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care. J Neurosurg Anesthesiol 2021; 34:257-276. [PMID: 34483301 DOI: 10.1097/ana.0000000000000799] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/14/2021] [Indexed: 11/25/2022]
Abstract
Evidence-based standardization of the perioperative management of patients undergoing complex spine surgery can improve outcomes such as enhanced patient satisfaction, reduced intensive care and hospital length of stay, and reduced costs. The Society for Neuroscience in Anesthesiology and Critical Care (SNACC) tasked an expert group to review existing evidence and generate recommendations for the perioperative management of patients undergoing complex spine surgery, defined as surgery on 2 or more thoracic and/or lumbar spine levels. Institutional clinical management protocols can be constructed based on the elements included in these clinical practice guidelines, and the evidence presented.
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Wang F, Wang SG, Yang Q, Nan LP, Cai TC, Wu DS, Zhang L. Cytotoxicity and Effect of Topical Application of Tranexamic Acid on Human Fibroblast in Spine Surgery. World Neurosurg 2021; 153:e380-e391. [PMID: 34224885 DOI: 10.1016/j.wneu.2021.06.125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE In spinal surgery, considerable blood loss is increasingly treated with the local application of tranexamic acid (TXA). However, little is known about its cytotoxicity and effect on human fibroblasts. This study was to identify the effect of TXA solution on human fibroblast at different concentrations and exposure times in vitro. METHODS To mimic the actual clinical situation, human fibroblasts were subjected to both limited and chronic exposure to various clinically relevant concentrations of TXA to mimic different ways of topical administration. At time points after treatment, the viability, proliferation, apoptosis, collagen synthesis, adhesion, and migration of fibroblasts were analyzed in vitro. RESULTS Limited exposure (10 minutes) to a high concentration of TXA (100 mg/mL) did not affect the viability, proliferation, and apoptosis of fibroblasts, and chronic exposure to low concentration of TXA (≤12.5 mg/mL) exerted little effect on viability, proliferation, apoptosis, collagen synthesis, adhesion, and migration of human fibroblasts (P > 0.05). However, the chronic exposure to a high concentration of TXA (≥25 mg/mL) can inhibit the viability, proliferation, collagen synthesis, adhesion and migration, and induce apoptosis of fibroblasts. CONCLUSIONS Although limited exposure to high concentration of TXA and chronic exposure to low concentration of TXA exerted little effect on fibroblasts, chronic exposure to high concentration of TXA can lead to fibroblast injury.
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Affiliation(s)
- Feng Wang
- Department of Orthopedic, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shu-Guang Wang
- Department of Orthopedic, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qian Yang
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Li-Ping Nan
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tong-Chuan Cai
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - De-Sheng Wu
- Department of Orthopedic, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Liang Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China.
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Tranexamic acid given into wound reduces postoperative drainage, blood loss, and hospital stay in spinal surgeries: a meta-analysis. J Orthop Surg Res 2021; 16:401. [PMID: 34158096 PMCID: PMC8220711 DOI: 10.1186/s13018-021-02548-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 06/09/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Although intravenous tranexamic acid administration (ivTXA) has prevailed in clinical antifibrinolytic treatment, whether it increases thromboembolic risks has remained controversial. As a potent alternative to ivTXA, topical use of TXA (tTXA) has been successfully applied to attenuate blood loss in various surgical fields while minimizing systemic exposure to TXA. This meta-analysis was conducted to gather scientific evidence for tTXA efficacy on reducing postoperative drainage, blood loss, and the length of hospital stay in spine surgeries. OBJECTIVES To examine whether topical use of TXA (tTXA) reduces postoperative drainage output and duration, hidden blood loss, hemoglobin level drop, hospital stay, and adverse event rate, we reviewed both randomized and non-randomized controlled trials that assessed the aforementioned efficacies of tTXA compared with placebo in patients undergoing cervical, thoracic, or lumbar spinal surgeries. METHODS An exhaustive literature search was conducted in MEDLINE and EMBASE databases from January 2000 through March 2020. Measurable outcomes were pooled using Review Manager (RevMan) version 5.0 in a meta-analysis. RESULTS Significantly reduced postoperative drainage output (weighted mean difference [WMD]= - 160.62 ml, 95% confidence interval (95% CI) [- 203.41, - 117.83]; p < .00001) and duration (WMD= - 0.75 days, 95% CI [- 1.09, - 0.40]; p < .0001), perioperative hidden blood loss (WMD= - 91.18ml, 95% CI [- 121.42, - 60.94]; p < .00001), and length of hospital stay (WMD= - 1.32 days, 95% CI [- 1.90, - 0.74]; p < .00001) were observed in tTXA group. Pooled effect for Hb level drop with tTXA vs placebo crossed the equivalent line by a mere 0.05 g/dL, with the predominant distribution of 95% confidence interval (CI) favoring tTXA use. CONCLUSIONS With the most comprehensive literature inclusion up to the present, this meta-analysis suggests that tTXA use in spinal surgeries significantly reduces postoperative drainage, hidden blood loss, and hospital stay duration. The pooled effect also suggests that tTXA appears more effective than placebo in preserving postoperative Hb level, which needs further validation by future studies.
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Hanada K, Ahmad A, Shadi H, Wajdi A, Haitham S, Wesam K, Lamees A, Qamar M, Rami A. Castigating intraoperative bleeding: Tranexamic acid, a new ally. Asian J Neurosurg 2021; 16:51-55. [PMID: 34211866 PMCID: PMC8202383 DOI: 10.4103/ajns.ajns_339_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/28/2020] [Accepted: 10/15/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction: The field of instrumented spinal procedures is associated with substantial blood volume losses, which is one of the major hazards we encounter; this would lead to a greater need for blood products transfusions. The frequent use of these products can have negative consequences due to body fluid shifting, and donor-host rejection. Thus, it has become mandatory to establish strategies to maintain blood volume and minimize losses. Several strategies have been approved to control the disproportionate blood loss. Objective: This study aims to assess the effectiveness of tranexamic acid in reducing intraoperative bleeding during our spine instrumented surgeries, while addressing complications associated. Methods: In this retrospective analysis was steered of 153- consecutive patients treated in the neurosurgical- spine unit of King Hussein hospital, King Hussein Medical Center (KHMC), between April 2017 to January 2020, patients who underwent instrumented surgery for different spinal pathologies at our institute were reviewed. Results: During the analysis period, 153-patients who underwent interbody fusion, were allocated into two groups. The mean instrumented segments were 2.8 level (range 1-5 levels). The demographical data of patients of both groups analyzed. The mean span of operating time was (212.74 ± 41.85 min) for group I, while for the control group mean length was (208.09min ±42.03). Study showed that the mean drop in the hemoglobin concentration postoperatively was statistically significant comparing the two groups. Analysis of blood volume in suction container showed that group I had: 470 ml ±153.06 ml; while in control group volume was: 1560 ml ± 567.59 ml, which showed significant difference (p = 0.002). Comparing the drainage volumes at 12 hours postoperatively displayed no statistically significant differences (p = 0.69) concerning the two groups. Minor adverse effects allied with the tranexamic acid administration. Conclusions: In summary, perioperative bleeding deemed one of the most important threat for patients. Tranexamic acid is proved excellent in controlling perioperative bleeding, harboring few contraindications. Future large studies are still needed to elaborate on unanswered issues.
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Affiliation(s)
- Krashan Hanada
- Department of Anesthesia, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Alhasan Ahmad
- Department of Anesthesia, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Hammadeen Shadi
- Department of Anesthesia, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Alnajada Wajdi
- Department of Radiation Oncology, Queen Alia Military Hospital, Royal Medical Services, Amman, Jordan
| | - Saraireh Haitham
- Department of Radiation Oncology, Queen Alia Military Hospital, Royal Medical Services, Amman, Jordan
| | - Khresat Wesam
- Department of Anesthesia, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Arabiyat Lamees
- Department of Plastic Surgery, Farah Medical Center, Royal Medical Services, Amman, Jordan
| | - Malabeh Qamar
- Department of Radiology, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Alqroom Rami
- Department of Neurosurgery, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
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Zhang R, Xing F, Yang Z, Lin G, Chu J. Analysis of risk factors for perioperative hidden blood loss in patients undergoing transforaminal lumbar interbody fusion. J Int Med Res 2020; 48:300060520937848. [PMID: 32772761 PMCID: PMC7418255 DOI: 10.1177/0300060520937848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective This study was performed to analyze the correlation between perioperative hidden blood loss (HBL) and the general condition of patients undergoing transforaminal lumbar interbody fusion (TLIF). Methods We retrospectively analyzed patients who underwent TLIF from July 2017 to July 2019 in our hospital. Sex, age, body mass index, underlying diseases, American Society of Anesthesiologists classification, coagulation function, preoperative and postoperative hemoglobin level and hematocrit, surgery time, fusion level, intraoperative blood loss, and drainage volume were recorded. Postoperative complications were also recorded. The amount of HBL was calculated, and its correlation with related variables was analyzed. Results The mean surgery time was 153.32 ± 54.86 minutes. The total perioperative blood loss was 789.22 ± 499.68 mL, including HBL of 315.69 ± 199.87 mL. Pearson correlation analysis showed statistically significant differences in HBL according to the body mass index, hypertension, fibrinogen, surgery time, and fusion level. Multiple linear regression analysis indicated that the surgery time and fusion level were independent risk factors for HBL. Conclusions A certain amount of HBL occurs in TLIF surgery and cannot be ignored in daily clinical work. The operation time and surgery level are independent risk factors for HBL.
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Affiliation(s)
- Rui Zhang
- Department of Spine Surgery, Hefei Orthopaedics Hospital, No. 58 Chaohu North Road, Hefei, Anhui Province, China
- Rui Zhang, Department of Spine Surgery, Hefei Orthopaedics Hospital, No. 58 Chaohu North Road, Hefei, Anhui Province 238000, China.
| | - Fei Xing
- Department of Spine Surgery, Hefei Orthopaedics Hospital, No. 58 Chaohu North Road, Hefei, Anhui Province, China
| | - Zhuqing Yang
- Department of Anesthesiology, Hefei Orthopaedics Hospital, No. 58 Chaohu North Road, Hefei, Anhui Province, China
| | - Guoxiong Lin
- Department of Spine Surgery, Hefei Orthopaedics Hospital, No. 58 Chaohu North Road, Hefei, Anhui Province, China
| | - Jianjun Chu
- Department of Spine Surgery, Hefei Orthopaedics Hospital, No. 58 Chaohu North Road, Hefei, Anhui Province, China
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Xiong Z, Liu J, Yi P, Wang H, Tan M. Comparison of Intravenous versus Topical Tranexamic Acid in Nondeformity Spine Surgery: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7403034. [PMID: 32219141 PMCID: PMC7085364 DOI: 10.1155/2020/7403034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/14/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Tranexamic acid (TXA), an antifibrinolytic agent, interferes with fibrinolysis and has been used for many years to reduce blood loss during spine surgery. The purpose of our meta-analysis was to compare the effect of intravenous versus topical administration of TXA in patients undergoing nondeformity spine surgery. METHODS We searched multiple databases, including PubMed, Embase, the Cochrane library, CNKI, WanFang database, and VIP to find studies that met the inclusion criteria. A meta-analysis was performed according to the guidelines of the Cochrane Reviewer's Handbook. RESULTS Eight randomized controlled trials (RCTs) were identified, including 660 patients. The surgical methods used in the included studies were nondeformity spine surgery. No significant differences were found in the two groups regarding total blood loss, intraoperative blood loss, hidden blood loss, hematocrit, hemoglobin, fibrinogen, postoperative prothrombin time (PT), postoperative activated partial thromboplastin time (APTT), drainage volume, and blood transfusion rate. There were statistically significant differences in the two groups in terms of preoperative PT (MD = -0.39, 95% CI: [-0.63, -0.15], P=0.002) and preoperative APTT (MD = 1.12, 95% CI: [0.57, 1.68], P=0.002) and preoperative APTT (MD = 1.12, 95% CI: [0.57, 1.68]. CONCLUSION During nondeformity spine surgery, intravenous administration of TXA did not have a significant effect on the decrease of blood loss and blood transfusion rate compared with the topical group. According to the pooled analysis of PT and APTT, intravenous and topical application of TXA may have different effects on the coagulation pathway. More high-quality RCTs are needed to explore the optimal dosage, method, timing in the future in order to recommend TXA widespread use in spine surgery.
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Affiliation(s)
- Zhencheng Xiong
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100029, China
- Department of Spine Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Junyuan Liu
- Peking University Aerospace School of Clinical Medicine, Beijing 100029, China
| | - Ping Yi
- Department of Spine Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Hao Wang
- Beijing University of Chinese Medicine, Beijing 100029, China
| | - Mingsheng Tan
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100029, China
- Department of Spine Surgery, China-Japan Friendship Hospital, Beijing 100029, China
- Beijing University of Chinese Medicine, Beijing 100029, China
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Fatima N, Barra ME, Roberts RJ, Massaad E, Hadzipasic M, Shankar GM, Shin JH. Advances in surgical hemostasis: a comprehensive review and meta-analysis on topical tranexamic acid in spinal deformity surgery. Neurosurg Rev 2020; 44:163-175. [PMID: 31938967 DOI: 10.1007/s10143-020-01236-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/12/2019] [Accepted: 01/02/2020] [Indexed: 11/30/2022]
Abstract
Tranexamic acid (TXA) is an effective and commonly used hemostatic agent for perioperative blood loss in various surgical specialties. It is being increasingly used in spinal deformity surgery. We aimed to evaluate the safety and efficacy of topical TXA (tTXA) compared to both placebo and/or intravenous (IV) TXA in patients undergoing spinal deformity surgery. We conducted a systematic review of the electronic databases using different MeSH terms from January 1970 to August 2019. Pooled and subgroup analysis was performed using fixed and random-effect model based upon the heterogeneity (I2). A total of 609 patients (tTXA: n = 258, 42.4%) from 8 studies were included. We found that there was a statistically significant difference in terms of (i) postoperative blood loss [mean difference (MD) - 147.1, 95% CI - 189.5 to - 104.8, p < 0.00001], (ii) postoperative hemoglobin level (MD 1.09, 95% CI 0.45 to 1.72, p = 0.0008), (iii) operative time (MD 7.47, 95% CI 2.94 to 12.00, p < 0.00001), (iv) postoperative transfusion rate [odds ratio (OR) 0.39, 95% CI 0.20 to 0.78, p = 0.007], postoperative drain output (MD, - 184.0, 95% CI - 222.03 to - 146.04, p < 0.00001), and (v) duration of hospital stay (MD - 1.14, 95% CI - 1.44 to - 0.85, p < 0.00001) in patients treated with tTXA compared to the control group. However, there was no significant difference in terms of intraoperative blood loss (p = 0.13) and complications (p = 0.23) between the two comparative groups. Furthermore, low-dose (250-500 mg) tTXA (p < 0.00001) reduced postoperative blood loss more effectively compared to high-dose tTXA (1-3 g) (p = 0.001). Our meta-analysis corroborates the effectiveness and safety of tTXA in spinal deformity surgery.
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Affiliation(s)
- Nida Fatima
- Department of Neurosurgery, Massachusetts General Hospital, Boston, USA.
| | - Megan E Barra
- Department of Clinical Pharmacist, Massachusetts General Hospital, Boston, USA
| | | | - Elie Massaad
- Department of Neurosurgery, Massachusetts General Hospital, Boston, USA
| | | | - Ganesh M Shankar
- Department of Neurosurgery, Massachusetts General Hospital, Boston, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston, USA
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