Cost Benefit Analysis Of Intravenous Injection Tranexamic Acid In Primary Total Knee Arthroplasty

BACKGROUND:Significant blood loss and resultant allogeneic bloodtransfusion are matters of great concern in total knee arthroplasty (TKA).Thereare several alternatives that have been studied to reduce transfusions in primaryknee joint arthroplasty. These options include predonation of autologous bloodfor possible postoperative use, the use of tourniquet in surgery procedures,redcell salvage technology, recombinant human erythropoietin (Epo), andaprotinin. The use of these way is associated with several negative eventsincluding increased vasovagal complications, increased transfusion rates, deepvein thrombosis and absence of cost effectiveness. However, Allogenic bloodtransfusion have its own negative events, including viral infections, hemolyticreactions and nosocomial infection. Therefore, it’s necessary to find ansecurity and effective way to reduce the blood loss and the requirement ofAllogenic blood transfusion. The TA is the same old product that is the subjectof ongoing randomized trials in orthopedic surgery today. It has proved to be aneffective drug; the evidence is overwhelming that TA reduces blood loss andtransfusion requirement and causes no apparent increase in vascular occlusiveevents. However, questions still persist regarding optimal dosing, the risk ofthrombosis and other adverse events, as well as possible new indications foruse.OBJECTIVE： To validate the blood transfusion requirements andinduced costs can be diminished by using TA intravenous injection premedication，and provide a cost–benefit analysis of intravenous injectiontranexamic acid (TXA) in primary knee arthroplasty patientsMATERIAL：A retrospective cohort of153consecutive patients form March,2014to February,2015,including70experimental and83control, October2014marked the day that each of these surgeons began to administerintravenous injection TXA to all total knee joint patients premedication. Themonths of August and September of2014were excluded from the study toprevent overlap of the experimental and control groups. All patients receivedepidural anesthesia，and preoperative antibiotics within30min of surgicalincision, typically cefuroxime, or clindamycin if significant cephalosporinallergy。Tourniquet, electrocautery was used to achieve hemostasis for allpatients。Preoperative tranexamic acid within30min of surgical. The bloodtransfusion cost was estimated using data form our hospital Blood Bank.Transfusion cost per1U RBC was estimated to be360yuan in2014at ourinstitution.The cost of1g of TXA was approximately62yuan in2014at ourinstitution.RESULT：There was no statistically significant difference in Length ofstay,complication, readmission, and KSS between the pre and post TXAgroups. The preoperative hemoglobin levels were similar with the controlgroup。 However， There was a significant difference in postoperativehemoglobin and delta hemoglobin values. The blood transfusion cost wasconfirmed with our hospital Blood Bank, Transfusion cost per1U RBC was estimated to be￥1022，The cost of1g of TXA was approximately￥62. therewas a savings of￥33600per100arthroplasty patients treated. In fulldiscussion,100arthroplasty patients receive TXA at￥62apiece, or￥6200total. With an observed reduction of allogeneic units transfused by35%withTXA then ($960*35)=￥33600saved for every100patients treated. By subtracting the acquisition costs of the TXA(￥6200) from this value, we found a net savings of￥33600per100treated, amounting to￥336per patient.CONCLUSION：1.There are have a significantly reduction in blood loss perioperative andthe requirement for allogeneic blood with intravenous injection TXA to totalknee joint patients premedication.2.It won’t addition the risk of length of stay, readmission and complicationwith intravenous injection TXA to total knee joint patients premedication3. With an observed reduction of allogeneic units transfused by35%withTXA then saved amounting to￥336per patient with intravenous injectionTXA to total knee joint patients premedication.