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Post-operative tranexamic acid decreases chest tube drainage following vertebral body tethering surgery for scoliosis correction

Abstract

Purpose

Anterior vertebral body tethering (VBT) is a non-fusion surgical treatment for Adolescent Idiopathic Scoliosis requiring chest tube(s) (CT). We sought to assess the efficacy of post-op intravenous tranexamic acid (IV TXA) in reducing CT drainage and retention.

Methods

35 VBT patients received 24 h of post-op IV TXA (2 mg/kg/h) were compared to 49 who did not. Group comparisons were performed using Wilcoxon rank-sum and chi-squared tests. Multivariate linear regression analysis was used to assess the relationships between TXA and both CT drainage and retention time.

Results

There were no group differences at baseline (Table). CTs placed for thoracic (T) and thoracolumbar (TL) curves were assessed separately. For TH CT, there was less total CT drainage in the TXA group (TXA 569.4 ± 337.4 mL vs. Non-TXA 782.5 ± 338.9 mL; p = 0.003) and shorter CT retention time (TXA 3.0 ± 1.3 vs. Non-TXA 3.9 ± 1.4 days; p = 0.003). For TL CT, there was less total CT drainage in the TXA group (TXA 206.8 ± 152.2 mL vs. Non-TXA 395.7 ± 196.1 mL; p = 0.003) and shorter CT retention time (TXA 1.7 ± 1.3 vs. Non-TXA 2.7 ± 1.0 days; p = 0.001). Following multivariate analysis, use of TXA was the only significant predictor of both drainage in T and TL CTs (p = 0.012 and p = 0.002, respectively) as well as T and TL CT retention time (p = 0.008 and p = 0.009, respectively). There were no differences in LOS (p = 0.863) or ICU stay (p = 0.290).

Conclusion

IV TXA results in a significant decrease in CT drainage and retention time. CT retention is decreased by 1 day for those that receive TXA.

Level of evidence

III.

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Availability of data and material

Data will be maintained for this study for up to 7 years post publication as required by our institution’s review board.

Code availability

Not applicable.

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Authors and Affiliations

Authors

Contributions

LE, SRS, LNH, JG, SG, JM, SD, BL: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data. Drafted the work or revised it critically for important intellectual content. Approved the version to be published. Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Baron Lonner.

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Conflict of interest

Dr. Lonner reports personal fees and royalty fees from Zimmer Biomet for The Tether implant. Dr. Lonner also reports personal fees, non-financial support and other from Depuy Synthes, personal fees, equity, and non-financial support from OrthoPediatrics, stocks/stock options from Spine Search, grants and other from Setting Scoliosis Straight Foundation, outside the submitted work. Dr. Hodo reports non-financial leadership roles as Executive Council, Section on Hospital Medicine, American Academy of Pediatrics and Executive Council, Pediatric Special Interest Group, Society of Hospital Medicine, out the submitted work. The remaining authors have no disclosures to report.

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This work was approved by the Institutional Review Board at Mount Sinai Hospital.

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This work was performed under a waiver of informed consent approved by the Institutional Review Board at Mount Sinai Hospital.

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Eaker, L., Selverian, S.R., Hodo, L.N. et al. Post-operative tranexamic acid decreases chest tube drainage following vertebral body tethering surgery for scoliosis correction. Spine Deform 10, 811–816 (2022). https://doi.org/10.1007/s43390-022-00492-x

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Keywords

  • Vertebral body tethering
  • Chest tube management
  • Tranexamic acid