Elsevier

The Journal of Arthroplasty

Volume 29, Issue 8, August 2014, Pages 1512-1515
The Journal of Arthroplasty

Cost Benefit Analysis of Topical Tranexamic Acid in Primary Total Hip and Knee Arthroplasty

https://doi.org/10.1016/j.arth.2014.01.031Get rights and content

Abstract

The purpose of this study was to provide a cost–benefit analysis of topical tranexamic acid (TXA) in primary total hip and knee arthroplasty patients. A retrospective cohort of 591 consecutive patients, 311 experimental and 280 control, revealed a transfusion rate reduction from 17.5% to 5.5%, increased postoperative hemoglobin, and decreased delta hemoglobin without an increase in adverse events (all P< 0.001). This led to saving $83.73 per patient based on transfusion costs alone after accounting for the cost of TXA. Hospital disposition to home compared to subacute nursing facility was also significantly increased by 9.3% (P< 0.02). We conclude that topical TXA reduces transfusion rate, increases home disposition, and reduces cost in primary hip and knee arthroplasty.

Section snippets

Materials and Methods

Following IRB approval, 591 primary, consecutive total joint arthroplasties performed by 5 orthopaedic surgeons at a single institution between March 2012 and March 2013 were retrospectively reviewed. September 1st 2012 marked the day that each of these surgeons began to administer topical TXA to all total joint patients intraoperatively. The months of August and September of 2012 were excluded from the study to prevent overlap of the experimental and control groups. The proportion of patients

Results

There was no statistically significant difference in demographics between the pre and post TXA groups. The control group (280 patients) consisted of 169 TKA and 111 THA; TKA made up 60.4% of the control group cases. The experimental TXA group (311 patients) consisted of 185 TKA and 126 THA; TKA made up 59.5% of the experimental group cases. Demographics are summarized in Table 1. This shows a nearly identical patient population in terms of gender, age, BMI, preoperative hemoglobin, and surgical

Discussion

Our institution has seen a marked reduction in transfusion rates since the implementation of topical TXA in total joint arthroplasty. We noted a 12% reduction in postoperative transfusion and an 18% reduction in the rate of RBC units transfused. The postoperative hemoglobin levels were significantly higher in the TXA group. The use of TXA saved $8372.66 per 100 patients based on transfusion cost alone. This amount does not factor in the cost of transfusion-related total joint complications.

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      While previous studies have investigated the cost-effectiveness of TXA for TJA in several different settings, none have accounted for differences in rates of PJI. After adjusting for the cost of TXA, Tuttle et al. (2014) found that its use led to savings of $87.73 per patient, just based on the cost of transfusions alone.22 The administration of TXA also had other notable benefits, including increased rates of discharge to home (instead of a skilled nursing facility) and higher post-operative hemoglobin.

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    The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2014.01.031.

    Reprint requests: John R. Tuttle, 593 Eddy St. Providence, RI 02903.

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