title: Association of Epsilon-Aminocaproic Acid With Blood Loss and Risk of Transfusion After Periacetabular Osteotomy: A Retrospective Cohort Study.
abstract: BACKGROUND
  Periacetabular osteotomy (PAO) reorients the acetabular cartilage through a complex series of pelvic osteotomies, which risks significant blood loss often necessitating blood transfusion. Therefore, it is important to identify effective strategies to manage blood loss and decrease morbidity after PAO. The purpose of this study was to determine the association of epsilon-aminocaproic acid (EACA), an antifibrinolytic agent, with blood loss from PAO.
  
  
  METHODS
  Ninety-three patients out of 110 consecutive patients that underwent unilateral PAO for acetabular dysplasia met inclusion criteria. Fifty patients received EACA intraoperatively. Demographics, autologous blood predonation, anesthetic type, intraoperative estimated blood loss (EBL), cell-saver utilization, and transfusions were recorded. Total blood loss was calculated. Two-sample t-test and chi-square or Fisher's exact test were used as appropriate. The associations between EACA administration and calculated EBL, cell-saver utilization, intraoperative EBL, and maximum difference in postoperative hemoglobin were assessed via multiple regression, adjusting for confounders. Post hoc power analysis demonstrated sufficient power to detect a 250-mL difference in calculated EBL between groups. Alpha level was 0.05 for all tests.
  
  
  RESULTS
  No demographic differences existed between groups. Mean blood loss and allogeneic transfusion rates were not statistically significant between groups (P = .093 and .170, respectively). There were no differences in cell-saver utilization, intraoperative EBL, and/or postoperative hemoglobin. There was a higher rate of autologous blood utilization in the group not receiving EACA because of a clinical practice change.
  
  
  CONCLUSIONS
  EACA administration was not associated with a statistically significant reduction in blood loss or allogeneic transfusion in patients undergoing PAO.
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: McLawhorn
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.
authors.forename: Ashley E
authors.initials: AE
authors.lastname: Levack
authors.affiliation: Healthcare Research Institute, Hospital for Special Surgery, New York, New York.
authors.forename: Kara G
authors.initials: KG
authors.lastname: Fields
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.
authors.forename: Evan D
authors.initials: ED
authors.lastname: Sheha
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, New York, New York.
authors.forename: Kathryn R
authors.initials: KR
authors.lastname: DelPizzo
authors.affiliation: Department of Orthopaedic Surgery, Center for Hip Preservation, Hospital for Special Surgery, New York, New York.
authors.forename: Ernest L
authors.initials: EL
authors.lastname: Sink
mesh_terms: D000077:Acetabulum / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D015119:Aminocaproic Acid / Q000627:therapeutic use*; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D005260:Female; D006617:Hip Dislocation / Q000601:surgery*; D006801:Humans; D008297:Male; D010027:Osteotomy; D019106:Postoperative Hemorrhage / Q000188:drug therapy / Q000517:prevention & control; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000933:Antifibrinolytic Agents; D015119:Aminocaproic Acid
keywords: antifibrinolytic agents; blood loss; epsilon-aminocaproic acid; periacetabular osteotomy; transfusion