The Effect of Systemic Tranexamic Acid on Hypercoagulable Complications and Perioperative Outcomes Following Three-Column Osteotomy for Adult Spinal Deformity

Abstract

Study Design: Retrospective cohort study. Objective: Thoracolumbar 3-column osteotomy (3CO) is a powerful technique for correction of rigid adult spinal deformity (ASD). However, it can be associated with high-volume blood loss. This study seeks to investigate the efficacy and safety of tranexamic acid (TXA) in 3CO ASD patients. Methods: ASD patients who underwent 3CO from 2006 to 2019 were retrospectively reviewed. Outcomes were compared between TXA and non-TXA patients, and TXA doses. Results: A total of 365 ASD patients were included: 181 TXA and 184 non-TXA. The mean age was 64.6 years and 60.5% were female. Operative time was shorter in the TXA group (295.6 vs 320.2 minutes, P < .001). However, TXA was not associated with shorter operative time (β = −6.5 minutes, 95% CI −29.0 to 15.9, P = .567) after accounting for surgeon experience. There was no difference in blood loss (2020.2 vs 1914.1 mL, P = .437) between groups. Overall complications (37.0% vs 33.2%, P = .439), including hypercoagulable (2.2% vs 3.8%, P = .373) and cardiac (13.3% vs 7.1%, P = .050) complications were similar between groups. TXA was not independently associated with blood loss or TXA-related complications. Both groups had comparable intensive care unit (2.5 vs 2.0 days, P = .060) and hospital (8.9 vs 8.2 days, P = .190) stays. There were no differences in outcomes between TXA dosing subgroups. Conclusions: Systemic TXA use during 3CO for ASD surgery was not associated with decreased blood loss. TXA patients had shorter operative times, but this was driven mainly by surgeon experience on multivariate analysis. Routine use of TXA is safe and does not increase the incidence of hypercoagulable complications even at high doses.

Is High-Dose Tranexamic Safe in Spine Surgery? A Systematic Review and Meta-Analysis

“…Second, follow-up times for our primary outcome varied among studies, with some reporting complication rates but not specifying follow up times. 7,9,20,26,40,[46][47][48][49] However, regardless of follow-up time, our findings were largely consistent, leading us to maintain our conclusions. Third, there may have been reporting bias among the studies in how complications were defined.…”

“…Our quality of evidence assessment for this conclusion is lower because this outcome was heterogeneously defined and reported by comparatively fewer studies. 10 , 20 , 27 , 41 Given that rates of surgical complications are highly variable among procedures, defining this outcome will require procedure-specific trials.…”

“…Analyzing the 3 comparative studies 21,26,27 that reported surgical outcomes also did not reveal any appreciable difference between HD and NHD groups (590 patients, OR = 1.23 [95% CI, .530 2.86]; P = .629; I 2 = 0%).…”