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

Tranexamic acid (TXA) reduces red blood cell transfusion in various orthopedic surgeries, yet the degree of practice variation its use among anesthesiologists and surgeons has not been described. To target future knowledge transfer implementation strategies, to better understand determinants variability prophylactic TXA use, our primary objective was evaluate influence surgical team members on administration. This a retrospective cohort study all adult patients undergoing total hip arthroplasty (THA), fracture surgery, spine fusion ± vertebrectomy at two Canadian hospitals between January 2014 December 2016. We used Classification Health Interventions procedure codes within Discharge Abstract Database which we linked Ottawa Data Warehouse. described percentage that received by individual specifics dosing, estimated effect using multivariable mixed-effects logistic regression analyses. In 3,900 studied, most commonly THA (85%; n = 1,344/1,582), with lower (23%; 342/1,506) surgery 186/812). The median [interquartile range] dose 1,000 [1,000–1,000] mg, given as bolus 92% cases. Anesthesiologists added significant odds receiving fusion, but THA. Most attributed patient other factors. confirmed routine THA, while observing utilization more surgery. Further is warranted variations barriers broader population high risk for transfusion.