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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.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery

|May 21, 2025

Summary

This summary is machine-generated.

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.

Keywords:

pediatric otolaryngology posttonsillectomy hemorrhage quality improvement tranexamic acid

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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.