Intraoperative tranexamic acid helps prevent infection in total joint arthroplasty: Study

Despite the common place use of tranexamic acid in total joint arthroplasty, much of the current data regarding its cost-effectiveness examines savings directly related to its hemostatic properties, without considering its protective effect against periprosthetic joint infections. A recent research conducted at the Hospital for Special Surgery, New York, USA found out that the routine use of intraoperative tranexamic acid is a highly cost-effective practice for infection prevention in primary and revision total joint arthroplasty.

The study is published in the Journal of Orthopaedics.

David A.Kolin and associates calculated the cost-effectiveness of routine tranexamic acid administration for infection prevention in total joint arthroplasty using the break-even economic modeling technique.

The cost of intraoperative intravenous tranexamic acid, the cost of revision arthroplasty for periprosthetic joint infections, and the baseline rates of periprosthetic joint infections in patients who did not receive intraoperative tranexamic acid were obtained from the literature and institutional purchasing records.

Break-even economic modeling incorporating these variables was performed to determine the absolute risk reduction in infection rate to make routine intraoperative tranexamic acid use economically justified. The number needed to treat was calculated from the absolute risk reduction.

The study revealed that the routine use of intraoperative tranexamic acid is economically justified if it prevents at least 1 infection out of 3125 total joint arthroplasties (absolute risk reduction = 0.032%). Also, the cost-effectiveness was maintained with varying costs of tranexamic acid, infection rates, and periprosthetic joint infection costs.

Hence, the authors concluded that "the routine use of intraoperative tranexamic acid is a highly cost-effective practice for infection prevention in primary and revision total joint arthroplasty."

The use of tranexamic acid is warranted across a wide range of costs of tranexamic acid, initial infection rates, and costs of periprosthetic joint infection treatment, they further added.

https://doi.org/10.1016/j.jor.2021.07.007