• Shawn G Anthony, Diana C Patterson, Paul J Cagle, Jashvant Poeran, Nicole Zubizarreta, Madhu Mazumdar, and Leesa M Galatz.
• From the Department of Orthopaedic Surgery (Dr. Anthony, Dr. Patterson, Dr. Cagle, and Dr. Galatz), Icahn School of Medicine at Mount Sinai Health System, and the Institute for Healthcare Delivery Science (Dr. Poeran, Ms. Zubizarreta, and Dr. Mazumdar), the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai Health System, New York, NY.
• J Am Acad Orthop Surg. 2019 Oct 1; 27 (19): 736-742.

IntroductionTranexamic acid (TXA) is increasingly used to reduce blood loss in lower extremity arthroplasty, but limited data exist for its effectiveness in patients undergoing shoulder arthroplasty. We aimed to use national data to assess the frequency of use and effectiveness of TXA in patients undergoing shoulder arthroplasty.MethodsUsing national claims data from patients undergoing shoulder arthroplasty (Premier Healthcare; 2010 to 2016; n = 82,512; 429 hospitals), we categorized patients according to whether they received perioperative TXA. Multilevel multivariable regression models measured associations between TXA and blood transfusion risk, combined complications (including thromboembolic events, acute renal failure, cerebral infarction, and acute myocardial infarction), and length and cost of hospitalization. Odds ratios (ORs) and 95% confidence intervals (CIs) are reported.ResultsOverall, TXA was used in 12.8% (n = 10,582) of patients with a strong increasing trend. After adjustment for relevant covariates, TXA use (compared with no TXA use) was associated with a 36% decrease in transfusion risk (OR, 0.64; 95% CI, 0.52 to 0.77; P < 0.05) and a 35% decreased risk for combined complications (OR, 0.65; 95% CI, 0.50 to 0.83; P < 0.05). Moreover, TXA use was associated with 6.2% shorter hospital stay (95% CI, -8.0% to -4.4%; P < 0.05), whereas no difference was observed with the cost of hospitalization.ConclusionIn this first large-scale study assessing TXA use and effectiveness in patients undergoing shoulder arthroplasty, we found that although TXA utilization is still low, it is associated with a marked decrease in transfusion risk with no increases in complication risk. Effects on the length and cost of hospitalization appeared minor. Future studies should assess whether higher volumes of TXA utilization would translate into more gains on the length and cost of hospitalization.Level Of EvidenceLevel III.

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