Utilization and Real-world Effectiveness of Tranexamic Use in Shoulder Arthroplasty: A Population-based Study

Area of Science:

• Orthopedic Surgery
• Pharmacology
• Health Services Research

Background:

• Limited data exist on tranexamic acid (TXA) effectiveness in shoulder arthroplasty.
• TXA is increasingly used for blood loss reduction in lower extremity procedures.

Purpose of the Study:

• Assess the utilization and effectiveness of TXA in shoulder arthroplasty.
• Evaluate TXA's impact on transfusion risk, complications, and hospitalization outcomes.

Main Methods:

• Analysis of national claims data (2010-2016) for 82,512 shoulder arthroplasty patients.
• Comparison of outcomes between patients receiving perioperative TXA and those who did not.
• Multilevel multivariable regression models to assess TXA's association with outcomes.

Main Results:

• TXA was used in 12.8% of patients, with a rising trend.
• TXA use was associated with a 36% decrease in transfusion risk (OR 0.64) and a 35% decrease in combined complications (OR 0.65).
• TXA use correlated with a 6.2% shorter hospital stay, but not with changes in hospitalization cost.

Conclusions:

• TXA utilization in shoulder arthroplasty is increasing but remains low.
• TXA is associated with significant reductions in transfusion risk and complications without increasing adverse events.
• Further research is needed to determine if higher TXA volumes yield greater benefits in hospital stay and cost.