Evaluation of Transfusion Practices in Noncardiac Surgeries at High Risk for Red Blood Cell Transfusion: A Retrospective Cohort Study

Houston, Brett L.; Fergusson, Dean; Falk, Jamie; Krupka, Emily; Perelman, Iris; Breau, Rodney H.; McIsaac, Daniel I.; Rimmer, Emily; Houston, Donald S.; Garland, Allan; Ariano, Robert E.; Tinmouth, Alan; Balshaw, Robert; Turgeon, Alexis F.; Jacobsohn, Eric; Park, Jason; Buduhan, Gordon; Johnson, Michael G.; Koulack, Joshua; Zarychanski, Ryan

doi:10.1016/j.tmrv.2020.08.001

Cited by 8 publications

(14 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All hospitals are tertiary care centres providing health services to approximately 2 million people. Surgeries were defined as ‘high risk’ if they were associated with a ≥5% incidence of perioperative RBC transfusion, using previously described methodology 3 (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

“…CCI codes were modified to reflect clinically relevant surgeries (Table S1). 3 To reflect transfusions attributable to perioperative bleeding, surgery‐specific transfusion rates were defined based on RBC transfusions from the start of the surgery to 7 days post‐operative or hospital discharge, whichever occurred first. Prophylactic TXA administration was defined as intravenous TXA initiated within 1 h before or after the start of surgery, with the intent to exclude cases where TXA was administered later in response to surgical bleeding.…”

Section: Methodsmentioning

confidence: 99%

“…Perioperative bleeding is a major indication for red blood cell (RBC) transfusion and is the second most common indication for transfusion in hospitalised patients 1,2 . Surgery‐specific transfusion rates in patients undergoing major non‐cardiac surgery vary widely, ranging from approximately 5% to 50% 3‐6 . Strategies to mitigate perioperative transfusion include pre‐operative correction of anaemia, variation in surgical technique, intraoperative blood salvage, restrictive transfusion thresholds and medications such as tranexamic acid (TXA) 7‐9 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prophylactic tranexamic acid use in non‐cardiac surgeries at high risk for transfusion

Houston

Fergusson

Falk

et al. 2021

Transfusion Medicine

Self Cite

View full text Add to dashboard Cite

Background Tranexamic acid (TXA) reduces transfusion in a wide range of surgical populations, although its real‐world use in non‐cardiac surgeries has not been well described. The objective of this study was to describe prophylactic TXA use in non‐cardiac surgeries at high risk for transfusion. Methods This is a retrospective cohort study of all adult patients undergoing major non‐cardiac surgery at ≥5% risk of perioperative transfusion at five Canadian hospitals between January 2014 and December 2016. Canadian Classification of Health Interventions procedure codes within the Discharge Abstract Database were linked to transfusion and laboratory databases. TXA use was ascertained electronically from The Ottawa Hospital Data Warehouse and via manual chart review for Winnipeg hospitals. For each surgery, we evaluated the percentage of patients who received TXA as well as the specifics of TXA dosing and administration. Results TXA use was evaluable in 14 300 patients. Overall, 17% of surgeries received TXA, ranging from 0% to 68% among individual surgeries. TXA use was more common in orthopaedic (n = 2043/4942; 41%) and spine surgeries (n = 239/1322; 18%) compared to other surgical domains (n = 109/8036; 1%). TXA was commonly administered as a bolus (n = 2097/2391; 88%). The median TXA dose was 1000 mg (IQR 1000–1000 mg). Conclusion TXA is predominantly used in orthopaedic and spine surgeries, with little uptake in other non‐cardiac surgeries at high risk for red blood cell transfusion. Further studies are needed to evaluate the effectiveness and safety of TXA and to understand the barriers to TXA administration in a broad range of non‐cardiac surgeries.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prophylactic tranexamic acid use in non‐cardiac surgeries at high risk for transfusion

Houston

Fergusson

Falk

et al. 2021

Transfusion Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…These orthopedic surgeries were chosen because they are high frequency surgeries (n [ 150 per year) with higher rates of RBC transfusion ([ 5%) and TXA utilization ([ 10%) within the cohort. 19 To prevent misclassification of surgery-specific rates of TXA utilization, we excluded patients with more than one surgery during their hospitalization. If a patient was readmitted for another surgery during the study period (2014-2016), we evaluated only their initial hospital admission (Fig.…”

Section: Study Design Setting and Populationmentioning

confidence: 99%

“…CCI procedure codes and ICD-10 diagnosis codes were used to define the orthopedic surgeries (eAppendix 1, Electronic Supplementary Material [ESM]). 19 Total hip arthroplasty for osteoarthritis was evaluated separately, whereas THA for hip fracture was included in the hip fracture surgery group. Hip fracture surgery comprised THA (for hip fracture), hip hemiarthroplasty, and hip open reduction internal fixation (ORIF).…”

Section: Study Variablesmentioning

confidence: 99%

Variation in prophylactic tranexamic acid administration among anesthesiologists and surgeons in orthopedic surgery: a retrospective cohort study

Houston

Fergusson

Falk

et al. 2021

Can J Anesth/J Can Anesth

Self Cite

View full text Add to dashboard Cite

Purpose Tranexamic acid (TXA) reduces red blood cell transfusion in various orthopedic surgeries, yet the degree of practice variation in its use among anesthesiologists and surgeons has not been described. To target future knowledge transfer and implementation strategies, and to better understand determinants of variability in prophylactic TXA use, our primary objective was to evaluate the influence of surgical team members on the variability of prophylactic TXA administration. Methods This was a retrospective cohort study of all adult patients undergoing primary total hip arthroplasty (THA), hip fracture surgery, and spine fusion ± vertebrectomy at two Canadian hospitals between January 2014 and December 2016. We used Canadian Classification of Health Interventions procedure codes within the

show abstract

Tranexamic Acid During Radical Cystectomy

Breau,

Lavallée,

Cagiannos

et al. 2024

JAMA Surg

View full text Add to dashboard Cite

ImportanceAmong cancer surgeries, patients requiring open radical cystectomy have the highest risk of red blood cell (RBC) transfusion. Prophylactic tranexamic acid (TXA) reduces blood loss during cardiac and orthopedic surgery, and it is possible that similar effects of TXA would be observed during radical cystectomy.ObjectiveTo determine whether TXA, administered before incision and for the duration of radical cystectomy, reduced the number of RBC transfusions received by patients up to 30 days after surgery.Design, Setting, and ParticipantsThe Tranexamic Acid During Cystectomy Trial (TACT) was a double-blind, placebo-controlled, randomized clinical trial with enrollment between June 2013 and January 2021. This multicenter trial was conducted in 10 academic centers. A consecutive sample of patients was eligible if the patients had a planned open radical cystectomy for the treatment of bladder cancer.InterventionBefore incision, patients in the intervention arm received a loading dose of intravenous TXA, 10 mg/kg, followed by a maintenance infusion of 5 mg/kg per hour for the duration of the surgery. In the control arm, patients received indistinguishable matching placebo.Main Outcomes and MeasuresThe primary outcome was receipt of RBC transfusion up to 30 days after surgery.ResultsA total of 386 patients were assessed for eligibility, and 33 did not meet eligibility. Of 353 randomized patients (median [IQR] age, 69 [62-75] years; 263 male [74.5%]), 344 were included in the intention-to-treat analysis. RBC transfusion up to 30 days occurred in 64 of 173 patients (37.0%) in the TXA group and 64 of 171 patients (37.4%) in the placebo group (relative risk, 0.99; 95% CI, 0.83-1.18). There were no differences in secondary outcomes among the TXA group vs placebo group including mean (SD) number of RBC units transfused (0.9 [1.5] U vs 1.1 [1.8] U; P = .43), estimated blood loss (927 [733] mL vs 963 [624] mL; P = .52), intraoperative transfusion (28.3% [49 of 173] vs 24.0% [41 of 171]; P = .08), or venous thromboembolic events (3.5% [6 of 173] vs 2.9% [5 of 171]; P = .57). Non–transfusion-related adverse events were similar between groups.Conclusions and RelevanceResults of this randomized clinical trial reveal that TXA did not reduce blood transfusion in patients undergoing open radical cystectomy for bladder cancer. Based on this trial, routine use of TXA during open radical cystectomy is not recommended.Trial RegistrationClinicalTrials.gov Identifier: NCT01869413

show abstract

Evaluation of Transfusion Practices in Noncardiac Surgeries at High Risk for Red Blood Cell Transfusion: A Retrospective Cohort Study

Cited by 8 publications

References 19 publications

Prophylactic tranexamic acid use in non‐cardiac surgeries at high risk for transfusion

Prophylactic tranexamic acid use in non‐cardiac surgeries at high risk for transfusion

Variation in prophylactic tranexamic acid administration among anesthesiologists and surgeons in orthopedic surgery: a retrospective cohort study

Tranexamic Acid During Radical Cystectomy

Contact Info

Product

Resources

About