Process Improvement Project Using Tranexamic Acid Is Cost-Effective in Reducing Blood Loss and Transfusions After Total Hip and Total Knee Arthroplasty.
Tranexamic acid (TXA) has been associated with decreased blood loss and transfusion after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to examine both transfusion utilization and the economic impact of a Process Improvement Project implementing TXA for THA and TKA.



After standardization of TXA administration in THA and TKA patients, retrospective data were compared from 12 consecutive months before (group A, n = 336 procedures) and after (group B, n = 436 procedures) project initiation.



TXA administration increased with project implementation (group A = 3.57%, group B = 86.01%) and was associated with reductions in perioperative hemoglobin decrement (20.2%), patients transfused (45%), and number of units transfused per patient (61.9%). Cost savings were notable per patient ($128) and annually program wide ($55,884) with the primary THA subgroup contributing the most to the savings. No increase in adverse effects was observed.



Standardized administration of TXA is an effective and economically favorable blood-reduction strategy for patients undergoing elective THA or TKA. Although reduction in transfusions with TXA may be greater after TKA, the economic and clinical impact of transfusion reduction is more substantial in THA patients.
Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina.
Harry A
HA
Demos
Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina.
Zilan X
ZX
Lin
Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina.
William R
WR
Barfield
Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina.
Sylvia H
SH
Wilson
Department of Enterprise Analytics, Medical University of South Carolina, Charleston, South Carolina.
Dawn C
DC
Robertson
Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina.
Vincent D
VD
Pellegrini
D000368:Aged; D000933:Antifibrinolytic Agents / Q000191:economics / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000191:economics / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000191:economics / Q000706:statistics & numerical data; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data; D003071:Cognition; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D058996:Quality Improvement; D012015:Reference Standards; D012189:Retrospective Studies; D014148:Tranexamic Acid / Q000191:economics / Q000627:therapeutic use*
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
arthroplasty of hip; arthroplasty of knee; cost saving; quality improvement; surgical blood loss; tranexamic acid