Tranexamic Acid Use for Posttonsillectomy Hemorrhage Across US Children's Hospitals

Area of Science:

• Pediatric Otolaryngology
• Pharmacology
• Health Services Research

Background:

• Post-tonsillectomy hemorrhage is a common complication in children.
• Tranexamic acid (TXA) is increasingly used to manage bleeding, but its trends and impact on outcomes require investigation.

Purpose of the Study:

• To analyze trends and variations in TXA administration for pediatric post-tonsillectomy hemorrhage.
• To evaluate the association between TXA treatment and reoperation or hospital admission.

Main Methods:

• Retrospective cross-sectional study using Pediatric Health Information System data (2016-2024).
• Included children (<18 years) with emergency encounters for post-tonsillectomy hemorrhage.
• Assessed TXA use trends, hospital-level variation, and encounter-level associations with reoperation and admission.

Main Results:

• TXA use increased from 0.0% in 2016 to 30.6% in 2024, with significant hospital-level variation (1.0% to 67.1%).
• TXA treatment was associated with lower adjusted odds of reoperation (aOR: 0.66).
• No significant association was found between TXA and hospital admission (aOR: 0.93).

Conclusions:

• A notable rise in TXA utilization for pediatric post-tonsillectomy bleeding was observed, alongside considerable inter-hospital variability.
• TXA administration correlated with decreased odds of reoperation but did not significantly impact hospital admission rates.