Tranexamic Acid in Patients With Cancer Undergoing Endoprosthetic Reconstruction: A Cost Analysis

Abstract

Introduction: Tranexamic acid (TXA) decreases blood loss, perioperative transfusion rates, and cost in total hip and total knee arthroplasty. In a previous study, topical TXA decreased both perioperative blood loss and transfusions in patients undergoing resection of aggressive bone tumors and endoprosthetic reconstruction. The purpose of this study was to explore the cost effectiveness of TXA in patients undergoing resection of an aggressive bone tumor and endoprosthetic reconstruction, assessing transfusion cost, TXA administration cost, postoperative hospitalization cost, posthospital disposition, and 30-day readmissions. Methods: This study included 126 patients who underwent resection of an aggressive bone tumor and endoprosthetic resection at a single academic medical center; 61 patients in the TXA cohort and 65 patients in the non-TXA cohort. The cost of 1 unit of packed red blood cells, not including administration or complications, was estimated at our institution. The cost of hospitalization was estimated for lodging and basic care. The cost of TXA was $55 per patient. Patients were followed up for 30 days to identify hospital readmissions. Results: Patients in the TXA cohort experienced a TXA and blood transfusion cost reduction of $155.88 per patient (P = 0.007). Proximal femur replacement patients experienced a $282.05 transfusion cost reduction (P = 0.008), whereas distal femur replacement patients only experienced a transfusion cost reduction of $32.64 (P = 0.43). An average hospital admission cost reduction of $5,072.23 per patient (P < 0.001) was associated with TXA use. Proximal femur replacement patients who received TXA experienced a hospital cost reduction of $5,728.38 (P < 0.001), whereas distal femur replacement patients experienced a reduction of $3,724.90 (P = 0.01). No differences between the cohorts were identified in discharge to home (P = 0.37) or readmissions (P = 0.77). Discussion: TXA administration is cost effective in patients undergoing resection of an aggressive bone tumor and endoprosthetic reconstruction through reducing both perioperative transfusion rates and postoperative hospitalization. Level of evidence: III—Retrospective Cohort Study

Tranexamic acid improves early postoperative mobilization in cancer patients undergoing endoprosthetic reconstruction

“…It would reason to be that the effect of TXA on postoperative length of stay in this study is similar to that seen in revision arthroplasty and bilateral total joint arthroplasty. This reduction in postoperative length of stay equates to a significant cost effectiveness of TXA in this patient population 13 . Importantly, this study identified that decreased length of stay was directly associated with increased ambulation on POD1 and POD2.…”

“…Patients in the TXA cohort also experienced a significant reduction in mean postoperative transfusion requirements, transfusion incidence, as well as a significant decrease in postoperative hospitalization length for patients undergoing PFR or DFR. Specific values for the data presented above can be found in the previously published works 12,13 . Multivariate linear regression analysis identified a significant inverse association between postoperative hospitalization length and POD1, postoperative Day (POD2), POD3, and total ambulation ( p < 0.001 for all values).…”

“…However, postoperative anemia, wound swelling, and pain from hemarthrosis are modifiable variables likely affecting a patient's ability to participate in PT. Previously, we found that TXA use was associated with decreased perioperative blood loss and transfusion rates in this patient population 12,13 . We hypothesized that through minimizing these variables, TXA use would increase postoperative ambulation.…”

“…Furthermore, we hypothesized that blood transfusions would be associated in longer postoperative hospitalization. This study is an extension of the previously published work evaluating TXA in cancer patients undergoing wide resection of bony tumors with endoprosthetic reconstruction 12,13 …”

“…[9][10][11] Improved recovery in this manor can result in decreased costs through increased patient independence, shorter hospital stays, and decreased need for posthospital rehabilitation facilities. 9 While the effectiveness of TXA in reducing perioperative blood loss, transfusion requirements, and postoperative hospitalization as well as its cost effectiveness have been demonstrated in patients undergoing wide resection of a bony tumor and endoprosthetic reconstruction, 12,13 no evidence exists outlining the influence TXA may have on postoperative mobilization, PT endurance, and posthospital discharge in this patient population.…”