Tranexamic Acid Reduces Perioperative Blood Loss in Pediatric Spinal Deformity Surgery​​​: A Retrospective Analysis in Nonidiopathic Scoliosis Patients.

STUDY

DESIGN

Retrospective cohort study.

OBJECTIVE

To assess the efficacy of tranexamic acid (TXA) on reducing perioperative blood loss and blood transfusion requirements in nonidiopathic scoliosis patients undergoing primary posterior spinal fusion.

SUMMARY OF BACKGROUND DATA: Posterior spinal fusion for correcting scoliosis in pediatric patients is associated with substantial volumes of perioperative blood loss and high transfusion requirements. Patients with nonidiopathic scoliosis typically experience greater blood loss than those with idiopathic scoliosis.

METHODS

We retrospectively reviewed patients who underwent primary posterior fusion for nonidiopathic scoliosis between November 2014 and December 2020. Patients were assigned to the TXA or no-TXA group depending on intraoperative administration of TXA.

RESULTS

Despite longer surgical duration ( P =0.009) and more spinal levels fused ( P =0.014), perioperative blood loss [2602 (810-9262) mL in the TXA group vs. 2058 (1019-4170) mL in the no-TXA group, P =0.554] and allogenic red blood cell transfusion rates (63% in the TXA group vs. 55% in the no-TXA group, P =0.508) were similar in the TXA and the no-TXA groups. After adjustments, TXA administration was found to have a significant negative effect on estimated blood loss (Est=-513.73, 95% CI=-925.41 to 125.3, P =0.045).

CONCLUSIONS

Significant perioperative blood loss and high transfusion rates remain a challenge in the surgical treatment of nonidiopathic scoliosis patients. Given the demonstrated negative effect of TXA on estimated blood loss, its routine application may be considered in the perioperative blood management of pediatric nonidiopathic scoliosis patients.

LEVEL OF EVIDENCE: Level III.