Effect of Intraoperative Tranexamic Acid on Perioperative Major Hemorrhage Requiring Transfusion in Patients Undergoing Elective Spine Surgery: A Propensity Score-Matched Analysis Using a National Inpatient Database

STUDY DESIGN

Retrospective cohort study.

OBJECTIVES

This study aimed to examine whether the use of intravenous TXA in elective spine surgery is associated with reduced perioperative massive hemorrhage requiring transfusion.

METHODS

We extracted all patients who underwent decompression with or without fusion surgery for the cervical, thoracic, and lumbar spine between April 2012 and March 2019. The primary outcome was the occurrence of massive hemorrhage requiring transfusion, defined as at least 560 mL of blood transfusion within 2 days of spine surgery or the requirement of additional blood transfusion from 3-7 days postoperatively. Secondary outcomes were the occurrence of thrombotic complications (pulmonary embolism, acute coronary syndrome, and stroke) and postoperative hematoma requiring additional surgery.

RESULTS

We identified 83,821 eligible patients, with 9747 (12%) patients in the TXA group. Overall, massive hemorrhage requiring transfusion occurred in 781 (.9%) patients. Propensity score matching yielded 8394 pairs. In the matched cohort, the TXA group had a lower proportion of massive hemorrhage requiring transfusion than the control group (.7% vs 1.1%; P = .002). There was no significant difference in the occurrence of thrombotic complications and postoperative hematoma requiring additional surgery between both groups. The multivariable regression analysis also showed that the use of TXA was associated with significantly lower proportions of massive hemorrhage requiring transfusion (odds ratio, .62; 95% confidence interval, .43-.90; P = .012).

CONCLUSIONS

In this analysis using real-world data, TXA use in elective spinal surgery was associated with reduced perioperative massive hemorrhage requiring transfusion without increasing thrombotic complications.

LEVEL OF EVIDENCE

Prognostic Level Ⅲ.

Complications following endoscopic submucosal dissection for gastric, esophageal, and colorectal cancer: a review of studies based on nationwide large-scale databases

Endoscopic submucosal dissection (ESD) is a relatively new procedure used for the treatment of early gastrointestinal cancers regardless of the lesion size and configuration, and it has gradually acquired popularity because of its minimally invasive nature. As compared to conventional endoscopic resection, ESD is a more complex procedure and requires a higher level of technical skill. Therefore, it is associated with a higher complication rate. Many previous studies that investigated the complication rates following ESD analyzed data from a limited number of specialized centers, possibly leading to an underestimation of the complication rates. Further, the relationship between hospital volume and complication rates is poorly understood. In the present study, we searched the MEDLINE and the Cochrane Library databases for studies that have reported on ESD-related complications and the relationship between hospital volume and ESD-related complication rates in a nationwide setting. The complication rates (including perforation, peritonitis, and bleeding) were 3.5% for gastric ESD, 3.3% for esophageal ESD, and 4.6% for colorectal ESD. The studies reviewed showed that ESD-related complication rates were permissibly low, and that there was a linear association between a higher hospital volume and a lower frequency of complications following ESD.