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Reducing Surgery for Pediatric Posttonsillectomy Hemorrhage Using Tranexamic Acid: A Quality Improvement Initiative
Laura A Petrauskas1, Janavi Sethurathnam2, Ansley J Kunnath2
1Department of Otolaryngology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.
Insights
Tranexamic acid (TXA) and observation effectively manage pediatric post-tonsillectomy hemorrhage (PTH), reducing surgeries and saving costs. This approach proved safe and cost-effective for managing PTH in children.
Area of Science:
- Pediatric Otolaryngology
- Surgical Quality Improvement
- Pharmacoeconomics
Background:
- Post-tonsillectomy hemorrhage (PTH) is a common complication in pediatric patients.
- Traditional management often involves return to the operating room, increasing costs and risks.
- A standardized protocol for managing PTH is needed.
Purpose of the Study:
- To evaluate the efficacy and safety of tranexamic acid (TXA) combined with observation for managing pediatric post-tonsillectomy hemorrhage (PTH).
- To assess the impact of a TXA protocol on the rate of return to the operating room for PTH.
- To determine the cost-effectiveness of this management strategy.
Main Methods:
- Retrospective analysis of a quality improvement initiative with historical controls.
- Inclusion of pediatric patients (<18 years) with PTH after adenotonsillectomy (AT).
- Implementation of intravenous TXA and overnight observation for stable patients; comparison of pre- and post-protocol periods.
Main Results:
- A significant reduction in return to the operating room for PTH was observed post-protocol (1.3 per 100 AT) compared to pre-protocol (2.2 per 100 AT).
- No adverse events were attributed to TXA administration.
- Estimated cost savings of $174,970 were achieved, with 21 avoided surgeries and 26 additional observed patients.
Conclusions:
- A standardized TXA protocol is an effective strategy for managing pediatric PTH.
- This approach significantly decreases the need for surgical reintervention.
- The TXA protocol offers a safe, cost-effective solution for healthcare systems managing PTH.
Objective:
Evaluate the use of tranexamic acid (TXA) and observation as a management option for pediatric patients presenting with posttonsillectomy hemorrhage (PTH).
Study Design:
Retrospective analysis of a prospectively implemented quality improvement initiative with a historical control comparison group.
Setting:
Tertiary children's hospital.
Methods:
Patients <18 years of age who underwent adenotonsillectomy (AT) and returned to the Emergency Department for PTH were included. Patients who were stable without large volume or active bleeding were given intravenous TXA and admitted for overnight observation. Data were compared in a before-and-after analysis: preprotocol (April 2022 to March 2023) versus postprotocol (April 2023 to March 2024). For cost-effectiveness analysis, we analyzed aggregated claims data from a commercial claims database.
Results:
Preprotocol 1800 adenotonsillectomies were performed, and 40 procedures were performed for control of hemorrhage (2.2 per 100 AT). Postprotocol 2356 adenotonsillectomies were performed, and 30 procedures were performed to control hemorrhage (1.3 per 100 AT) showing a significant reduction in return to the operating room (relative risk [RR] = 0.59, 95% confidence interval [CI] [0.358, 0.916], P-value .020). There were no reported adverse events attributable to TXA. An estimated 21 surgeries were avoided, and 26 additional patients were observed in the hospital during the postprotocol period, for an estimated net cost savings of $174,970.
Conclusion:
The implementation of a standardized TXA protocol significantly reduced the need for return to the operating room for PTH in pediatric patients, without complications and with net cost savings to the healthcare system.
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