title: Cost benefit analysis of the use of tranexamic acid in primary lower limb arthroplasty: A retrospective cohort study.
abstract: OBJECTIVE
  To examine the cost benefit conferred by the perioperative administration of intravenous tranexamic acid (TXA) in lower limb arthroplasty.
  
  
  METHODS
  This study evaluates the use of TXA in 200 consecutive lower limb arthroplasties performed in a single surgeon series. The initial 100 patients (control group) underwent surgery without perioperative administration of TXA while the subsequent 100 patients (TXA group) all received 1 g TXA at the time of induction of anaesthesia. Pre- and post-operative haemoglobin, platelet count, haematocrit, the use of blood product post-operatively, length of stay were examined. A financial analysis of both groups was then undertaken.
  
  
  RESULTS
  The mean age of patients in both groups was 63 ± 13 years. There were no significant differences between groups in terms of gender (P = 0.47), proportion of total hip replacement to total knee replacement (P = 0.25) or pre-operative haemoglobin (P = 0.43). In the control group, the transfusion rate was 22%. In the TXA group, the transfusion rate dropped to 2% (P < 0.001). The mean post-operative haemoglobin was 10.82 ± 1.55 g/dL in the control group vs 11.33 ± 1.27 g/dL in the TXA group (P = 0.01). The total cost of transfused blood products was €11055 and €603 respectively. The mean length of stay in the control group was 6.53 ± 5.93 d vs 5.47 ± 4.26 d in the TXA group (P = 0.15) leading to an estimated financial saving of €114586. There was one pulmonary embolus in the control group and one deep venous thrombosis in the TXA group.
  
  
  CONCLUSIONS
  Intravenous TXA reduces blood loss in lower limb arthroplasty. This leads to lower transfusion rates, shorter length of stay in hospital and significant financial savings.
authors.affiliation: Niall P McGoldrick, Eabhann M O'Connor, Nikos Davarinos, John F Quinlan, Department of Trauma and Orthopaedic Surgery, Tallaght Hospital, Dublin D24 NR0A, Ireland.
authors.forename: Niall P
authors.initials: NP
authors.lastname: McGoldrick
authors.affiliation: Niall P McGoldrick, Eabhann M O'Connor, Nikos Davarinos, John F Quinlan, Department of Trauma and Orthopaedic Surgery, Tallaght Hospital, Dublin D24 NR0A, Ireland.
authors.forename: Eabhann M
authors.initials: EM
authors.lastname: O'Connor
authors.affiliation: Niall P McGoldrick, Eabhann M O'Connor, Nikos Davarinos, John F Quinlan, Department of Trauma and Orthopaedic Surgery, Tallaght Hospital, Dublin D24 NR0A, Ireland.
authors.forename: Nikos
authors.initials: N
authors.lastname: Davarinos
authors.affiliation: Niall P McGoldrick, Eabhann M O'Connor, Nikos Davarinos, John F Quinlan, Department of Trauma and Orthopaedic Surgery, Tallaght Hospital, Dublin D24 NR0A, Ireland.
authors.forename: Rose
authors.initials: R
authors.lastname: Galvin
authors.affiliation: Niall P McGoldrick, Eabhann M O'Connor, Nikos Davarinos, John F Quinlan, Department of Trauma and Orthopaedic Surgery, Tallaght Hospital, Dublin D24 NR0A, Ireland.
authors.forename: John F
authors.initials: JF
authors.lastname: Quinlan
keywords: Arthroplasty; Cost-benefit analysis; Hip; Knee; Tranexamic acid