Reducing Surgery for Pediatric Posttonsillectomy Hemorrhage Using Tranexamic Acid: A Quality Improvement Initiative

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.