Archives of Orthopaedic and Trauma Surgery - 2026-03-16 - Journal Article
Tranexamic acid reduces transfusion requirements after pelvic osteotomy: a nationwide propensity score-matched analysis.
Tanaka H, Tarasawa K, Mori Y, Baba K, Kurishima H, Kanabuchi R, Kawamata H, Fukuchi H, Fushimi K, Fujimori K, Aizawa T
Topics
Key Takeaway
Perioperative TXA in pelvic osteotomy reduced cumulative 3-day transfusion volume by 130 g (598.8 vs. 728.6 g) without increasing DVT, PE, infection, or reoperation rates in a propensity-matched cohort of 7,084 patients.
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Summary
This study asked whether perioperative TXA reduces transfusion burden and complicates safety in patients undergoing pelvic osteotomy, using the Japanese Diagnosis Procedure Combination database (December 2011–March 2023) with 1:1 propensity score matching. TXA was associated with significantly lower transfusion likelihood on POD 0 and POD 1 and reduced cumulative 3-day transfusion volume (598.8 vs. 728.6 g, p<0.05). The transfusion reduction was driven primarily by decreased autologous blood use; allogeneic transfusion rates were comparable between groups, and no significant increase in PE, DVT, infection, or reoperation was observed.
Key Limitation
The administrative database lacks granular data on TXA dosing regimen, route of administration, and timing relative to incision, making it impossible to determine which protocol achieves the observed benefit.
Original Abstract
INTRODUCTION
Pelvic osteotomy is frequently associated with substantial perioperative blood loss due to the highly vascularized pelvic anatomy. Tranexamic acid (TXA) is widely used to reduce blood loss in total hip arthroplasty; however, evidence supporting its use in pelvic osteotomy, particularly in Asian populations, remains limited. This study evaluated the association between perioperative TXA use, transfusion requirements, and postoperative complications in patients undergoing pelvic osteotomy in Japan.
MATERIALS AND METHODS
Using the Japanese Diagnosis Procedure Combination nationwide administrative database, we retrospectively identified patients who underwent pelvic osteotomy between December 2011 and March 2023. Patients receiving perioperative TXA were compared with those who did not, using one-to-one propensity score matching. Outcomes included transfusion rates on postoperative days 0–2, cumulative transfusion volume, and in-hospital complications, including infection, deep vein thrombosis, pulmonary embolism (PE), and reoperation.
RESULTS
After matching, 3,542 patients were included in each group. TXA use was independently associated with a significantly lower likelihood of blood transfusion on postoperative days 0 (95% CI, 0.552–0.693; p < 0.05) and 1 (95% CI, 0.472–0.579; p < 0.05). The cumulative transfusion volume over the first three postoperative days was significantly lower in the TXA group than in the non-TXA group (598.8 ± 408.0 g vs. 728.6 ± 426.5 g; p < 0.05). While autologous transfusion use differed, allogeneic transfusion rates were comparable. Subgroup analysis demonstrated that this reduction in overall transfusion was primarily attributable to a significantly lower utilization of autologous blood transfusion, whereas allogeneic transfusion rates were comparable between the groups. No significant increase in infection, PE, or reoperation was observed.
CONCLUSIONS
Perioperative TXA use was associated with reduced transfusion requirements after pelvic osteotomy without compromising short-term safety, supporting its use within contemporary perioperative management in Japan.