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Tranexamic Acid Use for Posttonsillectomy Hemorrhage Across US Children's Hospitals
Kelly R Bergmann1, Matt Hall2, Sriram Ramgopal3
1Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN.
Insights
Tranexamic acid (TXA) use for pediatric post-tonsillectomy bleeding significantly increased, showing wide hospital variation. TXA treatment was linked to reduced reoperation rates but not hospital admissions.
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.
Objectives:
To determine trends and variation in tranexamic acid (TXA) use and to determine whether treatment with TXA is associated with reoperation or hospital admission for children with posttonsillectomy hemorrhage.
Methods:
We conducted a retrospective, cross-sectional study of children (<18 y old) with an emergency department encounter for posttonsillectomy hemorrhage from January 1, 2016, to December 31, 2024, using Pediatric Health Information System data. The primary outcome was treatment with TXA. Secondary outcomes included reoperation, hospital admission, and patient factors. We calculated annual hospital-level median percentages and used the Cochran-Armitage test to assess for trends in TXA use when ranked by quartile. We assessed the encounter-level association between secondary outcomes and TXA administration.
Results:
A total of 19,572 encounters were included. The median age was 7 years (IQR: 4 to 11 y). TXA was used in 1892 (9.7%) encounters. TXA use ranged from 1.0% to 67.1% across hospitals. Median annual TXA use increased from 0.0% in 2016 to 30.6% in 2024. At the hospital level, we observed no difference in reoperation ( P =0.941) or hospital admission ( P =0.060) by hospital quartile of TXA use. At the encounter level, treatment with TXA was associated with lower adjusted odds of reoperation (aOR: 0.66, 95% CI: 0.56-0.77) but not hospital admission (aOR: 0.93, 95% CI: 0.83-1.04).
Conclusions:
We observed a significant increase in TXA use for posttonsillectomy hemorrhage, with substantial hospital-level variation. TXA use was associated with lower odds of reoperation but not hospital admission.
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