The application of tranexamic acid in degenerative lumbar scoliosis patients undergoing posterior osteotomy and multi-level posterior spinal segmental instrumented fusion

English Keywords:Tranexamic acid  Degenerative lumbar scoliosis  Multi-level spinal instrumented fusion  Transfusion

English Abstract:

  【Abstract】 Objectives: To evaluate the efficacy and safety of tranexamic acid in degenerative lumbar scoliosis(DLS) patients undergoing posterior osteotomy and multi-level spinal segmental instrumented fusion surgery. Methods: A total of 101 consecutive patients undergoing posterior osteotomy and multi-level spinal segmental instrumented fusion(≥4 levels) was analyzed retrospectively. Patients receiving intraoperative tranexamic acid(TXA) were included in the tranexamic acid group(TXA group), while patients not receiving intraoperative TXA were given the same amount of saline and included in the control group(Placebo group). Preoperative and postoperative data within 6 weeks were compared between the two groups, including patient basic information, complications, surgical data, postoperative complications and medical costs. Outcome parameters included intra-operative blood loss(IBL), postoperative drainage, total blood loss(TBL), perioperative transfusion amount, rate of transfusion, transfusion cost and perioperative complications. Enter multiple regression analysis was performed to investigate the independent risk factors of TBL, transfusion value and the cost of transfusion. Results: 41 patients were enrolled in the TXA group, and 60 patients were in the Placebo group. There was no statistical difference in the baseline data, preoperative radiographic parameters and laboratory parameters between the groups. There was a significant decrease in the IBL(TXA group 1245.22±770.61ml vs Placebo group 1633.65±962.49ml, P=0.021), postoperative drainage(TXA group 1205.68±367.76ml vs Placebo group 1412.83±538.45ml, P=0.035) and TBL(TXA group 2450.90±1022.69ml vs Placebo group 3046.48±1274.02ml, P=0.011). In the TXA group, intraoperative autologous blood transfusion volume was 400.44±267.80ml, while in the control group it was 526.22±339.96ml, showing statistical significance(P=0.031). The intraoperative allogeneic blood transfusion volume and transfusion rate of patients in the TXA group were also significantly lower than those in the control group(TXA group 468.29±391.43ml vs Placebo group 723.33±462.99ml, P=0.009; TXA group 68.29% vs Placebo group 86.67%, P=0.025). The total perioperative blood transfusion volume of the TXA group was 746.34±460.49ml, significantly lower than that of the control group (1143.33±669.02ml). The perioperative blood transfusion cost of the TXA group was 969.76±840.24 yuan, while that of the control group was 1460.67±1029.51 yuan, TXA could significantly reduce perioperative blood transfusion cost(P=0.005). Based on multiple regression analysis, intra-operative use of 1g TXA could reduce the amount of TBL, total allogenic transfusion, transfusion cost by 689.89ml, 390.26ml and 549.11 respectively. No complication or side effect from the use of TXA was noted. Conclusions: The use of TXA in DLS patients undergoing posterior osteotomy and multi-level spinal segmental instrumented fusion surgery seems to be valid, safe and cost-effective.