Perioperative outcomes following tranexamic acid use in arthroscopic rotator cuff repair

Tranexamic acid (TXA) is widely used in orthopedic surgery to mitigate intraoperative and post-operative bleeding. Current literature supports its use in arthroscopic rotator cuff repair (RCR) to increase visualization, decrease operative time, and improve immediate post-operative pain. This study aimed to assess post-operative outcomes of arthroscopic RCR with and without perioperative TXA. We hypothesize that TXA use will result in decreased post-operative complications, including less pain and therefore fewer opioid prescriptions.

The TriNetX database was queried to assess post-operative outcomes after arthroscopic RCR with and without perioperative TXA performed between January 1, 2010, and December 31, 2024. Post-operative outcomes were evaluated at one month and followed for one year. Evaluated outcomes included emergency department visits, hospital admissions, superficial and deep surgical site infections, pulmonary embolism, and number of opioid prescriptions. One-to-one greedy propensity score matching was performed to control for potential confounding variables, and odds ratios were calculated to assess the overall risk of the outcomes of interest between cohorts. A t-test was performed to evaluate differences in the number of opioid prescriptions. Statistical analysis was set at P < .05 for all analyses.

We identified 120,236 RCR without perioperative TXA and 7,645 RCR with perioperative TXA. After matching based on demographics and medical comorbidities, 7,645 patients remained in each cohort. Analysis at both 1 month and 1 year post-operative demonstrated that patients receiving perioperative TXA were associated with fewer opioid prescriptions (27.9% versus 31.2% at 30 days and 43.5% versus 47.2% at 1 year, P < .0001). The perioperative TXA cohort also had decreased odds of readmission at 1 year but not 30 days (0.2% versus 0.6%, P < .0001). No significant differences were found in pulmonary embolism rates or superficial and deep surgical site infections.

This is the first large-scale, database study demonstrating perioperative TXA in the setting of arthroscopic RCR was associated with significantly improved post-operative outcomes, particularly fewer post-operative opioid prescriptions at 30 days and 1 year and a decrease in hospital admissions at 1-year follow-up. This updates the limited current literature surrounding TXA use during shoulder arthroscopy, with some studies suggesting improved visual field and decreased immediate post-operative pain, while others positing no clinical difference in pain reduction. Future well-designed prospective studies are needed to elucidate these associations more fully.