Pelvis and Acetabulum

Session: Annual Meeting Podium Session VI: Pelvis Acetabulum and Pain Management

Tranexamic Acid Does Not Decrease Transfusion Requirements in Patients Undergoing Anterior Intrapelvic Approach for Acetabular ORIF

Friday, October 20, 2023

3:37 PM – 3:43 PM PST

Location: 4B

Presenting Author / Corresponding Author(s)

BM

Brian H. Mullis, MD, FIOTA (he/him/his)

Vice Chair and Program Director
Indiana University Department of Orthopaedics
Zionsville, Indiana, United States

Disclosure(s): Smith & Nephew: Speakers Bureau (Ongoing); Zimmer Biomet: Other Financial or Material Support (Ongoing)

Co-Author(s)

Michael Archdeacon, MD, MSE (he/him/his)

Chief Executive Officer, University of Cincinnati Physicians, Senior Associate Dean of Clinical Affairs, Peter J. 1Stern Professor & Chair, Department of Orthopaedic Surgery
University of Cincinnati College of Medicine
Cincinnati, Ohio, United States
JC

Joshua Chang, BS
Roman M. Natoli, MD, PhD

Indiana University Health
Indianaopolis, Indiana, United States
Rs

Ramsey sabbagh, MD
HS

H. Claude Sagi, MD

professor
University of Cincinnati College of Medicine
Cincinnati, Ohio, United States
NS

Nihar Samir Shah, MD

University of Cincinnati

Purpose: The objective of this study was to determine factors that may affect transfusion rates for patients requiring an anterior intrapelvic (AIP) approach.

Methods: This is an IRB-approved retrospective study spanning 2013–2020 at three Level I trauma centers. 192 patients who underwent unilateral AIP for open reduction and internal fixation (ORIF) of an acetabular fracture were included. Data analyzed included time duration from admission to surgery, estimated blood loss (EBL), intraoperative and postoperative transfusions, preoperative and daily postoperative hemoglobin (Hb), and use of tranexamic acid (TXA). Bivariate and multivariate regression models fit to the data analyses were performed to identify factors associated with transfusion.

Results: Factors that were found to affect intraoperative transfusion rates were older age, lower preoperative hematocrit, longer surgery duration, and requiring increased intraoperative intravenous fluids. Factors found that did not affect transfusion rate included gender, body mass index, hip dislocation at time of injury, fracture pattern, AIP approach alone or with lateral window ± distal extension, ISS, preoperative platelet count, use of TXA, admission time to operating room (OR), and deep venous thrombosis (DVT) prophylaxis received morning of surgery (Table 1). If followed out through the remainder of a week following surgery, the results for any factor did not change.

Conclusion: In this large multicenter retrospective study of patients requiring an AIP approach, TXA and use of DVT prophylaxis (or holding it the morning of surgery) did not affect transfusion rates either during surgery or up to a week following surgery. Older age, lower preoperative hematocrit level, longer surgery time, and increased intraoperative intravenous fluids were associated with higher transfusion rates.
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