Study design:

Retrospective Cohort Study OBJECTIVE: The purpose of this study was to evaluate the effect of tranexamic acid (TXA) on reducing perioperative blood loss and length of stay after transforaminal lumbar interbody fusion (TLIF).

Summary of background data:

Spine surgery is associated with the potential for significant blood loss, and adequate hemostasis is essential to visualizing crucial structures during the approach and procedure. Although TXA use has been extensively studied in the pediatric and adult spinal deformity literature, there is a dearth of literature on its efficacy in reducing blood loss for one- to three-level TLIF patients.

Methods:

All patients requiring one- to three-level TLIF who received a pre-operative loading dose of TXA were grouped and compared to patients who didn’t receive TXA. Demographic, surgical, and laboratory values were collected and analyzed. Continuous and categorical variables were analyzed with Chi-squared, Kruskal-Wallis, or Analysis of Variance tests, depending on normality and data type. Multiple linear regressions were developed to determine independent predictors of the estimated blood loss (EBL), total blood loss (TBL), drain output, and length of stay. Statistical significance was set at P <0.05.

Results:

Patients who received pre-operative TXA had more comorbidities (p=0.006), longer surgery length (p<0.001), and longer length of stay (p=0.004). TXA was independently associated with a decreased day 0, 1, 2, and total drain output (p<0.001, p=0.001, p=0.007, p<0.001, respectively), but was not associated with a change in estimated blood loss (EBL), total blood loss (TBL), or length of stay (LOS).

Conclusion:

The application of pre-operative TXA for patients undergoing one- to three-level TLIF reduced drain output in the first two postoperative days, but it did not affect hospital length of stay, total blood loss, or EBL.