TY - JOUR
T1 - Utilization and Real-world Effectiveness of Tranexamic Use in Shoulder Arthroplasty
T2 - A Population-based Study
AU - Anthony, Shawn G.
AU - Patterson, Diana C.
AU - Cagle, Paul J.
AU - Poeran, Jashvant
AU - Zubizarreta, Nicole
AU - Mazumdar, Madhu
AU - Galatz, Leesa M.
N1 - Publisher Copyright:
© American Academy of Orthopaedic Surgeons.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Introduction:Tranexamic acid (TXA) is increasingly used to reduce blood loss in lower extremity arthroplasty, but limited data exist for its effectiveness in patients undergoing shoulder arthroplasty. We aimed to use national data to assess the frequency of use and effectiveness of TXA in patients undergoing shoulder arthroplasty.Methods:Using national claims data from patients undergoing shoulder arthroplasty (Premier Healthcare; 2010 to 2016; n = 82,512; 429 hospitals), we categorized patients according to whether they received perioperative TXA. Multilevel multivariable regression models measured associations between TXA and blood transfusion risk, combined complications (including thromboembolic events, acute renal failure, cerebral infarction, and acute myocardial infarction), and length and cost of hospitalization. Odds ratios (ORs) and 95% confidence intervals (CIs) are reported.Results:Overall, TXA was used in 12.8% (n = 10,582) of patients with a strong increasing trend. After adjustment for relevant covariates, TXA use (compared with no TXA use) was associated with a 36% decrease in transfusion risk (OR, 0.64; 95% CI, 0.52 to 0.77; P < 0.05) and a 35% decreased risk for combined complications (OR, 0.65; 95% CI, 0.50 to 0.83; P < 0.05). Moreover, TXA use was associated with 6.2% shorter hospital stay (95% CI,-8.0% to-4.4%; P < 0.05), whereas no difference was observed with the cost of hospitalization.Conclusion:In this first large-scale study assessing TXA use and effectiveness in patients undergoing shoulder arthroplasty, we found that although TXA utilization is still low, it is associated with a marked decrease in transfusion risk with no increases in complication risk. Effects on the length and cost of hospitalization appeared minor. Future studies should assess whether higher volumes of TXA utilization would translate into more gains on the length and cost of hospitalization.Level of Evidence:Level III.
AB - Introduction:Tranexamic acid (TXA) is increasingly used to reduce blood loss in lower extremity arthroplasty, but limited data exist for its effectiveness in patients undergoing shoulder arthroplasty. We aimed to use national data to assess the frequency of use and effectiveness of TXA in patients undergoing shoulder arthroplasty.Methods:Using national claims data from patients undergoing shoulder arthroplasty (Premier Healthcare; 2010 to 2016; n = 82,512; 429 hospitals), we categorized patients according to whether they received perioperative TXA. Multilevel multivariable regression models measured associations between TXA and blood transfusion risk, combined complications (including thromboembolic events, acute renal failure, cerebral infarction, and acute myocardial infarction), and length and cost of hospitalization. Odds ratios (ORs) and 95% confidence intervals (CIs) are reported.Results:Overall, TXA was used in 12.8% (n = 10,582) of patients with a strong increasing trend. After adjustment for relevant covariates, TXA use (compared with no TXA use) was associated with a 36% decrease in transfusion risk (OR, 0.64; 95% CI, 0.52 to 0.77; P < 0.05) and a 35% decreased risk for combined complications (OR, 0.65; 95% CI, 0.50 to 0.83; P < 0.05). Moreover, TXA use was associated with 6.2% shorter hospital stay (95% CI,-8.0% to-4.4%; P < 0.05), whereas no difference was observed with the cost of hospitalization.Conclusion:In this first large-scale study assessing TXA use and effectiveness in patients undergoing shoulder arthroplasty, we found that although TXA utilization is still low, it is associated with a marked decrease in transfusion risk with no increases in complication risk. Effects on the length and cost of hospitalization appeared minor. Future studies should assess whether higher volumes of TXA utilization would translate into more gains on the length and cost of hospitalization.Level of Evidence:Level III.
UR - http://www.scopus.com/inward/record.url?scp=85072746489&partnerID=8YFLogxK
U2 - 10.5435/JAAOS-D-18-00206
DO - 10.5435/JAAOS-D-18-00206
M3 - Article
C2 - 30964754
AN - SCOPUS:85072746489
SN - 1067-151X
VL - 27
SP - 736
EP - 742
JO - The Journal of the American Academy of Orthopaedic Surgeons
JF - The Journal of the American Academy of Orthopaedic Surgeons
IS - 19
ER -