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Scientific Oral Presentations

Pediatric Otolaryngology

Session: Scientific Oral Presentations 1 - Pediatric Otolaryngology

Reducing Surgery for Pediatric Posttonsillectomy Hemorrhage Using Tranexamic Acid: A Quality Improvement Initiative

Saturday, September 28, 2024
9:30 AM – 9:36 AM EDT
Location: MBCC, 225
Disclosure(s):
Laura A. Petrauskas, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Christopher T. Wootten, MD, MMHC:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

James D. Phillips, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Ryan H. Belcher, MD, MPH:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Amy S. Whigham, MD, MS-HPEd:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Jay a. Werkhaven, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Lyndy J. Wilcox, MD, MMHC:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Frank W. Virgin, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Post-tonsillectomy hemorrhage (PTH) remains a significant complication of adenotonsillectomy (AT). Typical management strategies for PTH include readmission for observation and surgery to control bleeding. Recently, studies have suggested the use of tranexamic acid (TXA) could be effective in preventing or treating PTH. We therefore designed and implemented a protocol for the use of intravenous (IV) TXA for patients presenting with PTH starting in 2022.

Methods: This is an analysis of outcomes at one year after prospective implementation of a TXA protocol at a tertiary children’s hospital, using a historical control for comparison. Patients under 18 years of age who underwent AT and met inclusion criteria were given IV TXA and monitored overnight; those meeting exclusion criteria including large volume active bleeding or who developed subsequent bleeding while on TXA were taken to the OR. Aggregated data from a commercial claims database was used for cost-effectiveness analysis.

Results: Data were compared between two time periods: Pre-protocol (April 2022-March 2023) and post-protocol (April-March 2024). Pre-protocol, 2,539 TA were performed and 3% required return to OR. Post-protocol, 2,835 TA were performed and 1.3% required return to OR, showing significant reduction in return to OR (relative risk (RR) = 0.43). There were no severe adverse events attributable to TXA. An estimated 48 surgeries were averted, translating to an estimated net cost savings of $325,880.

Conclusions: This is the first study examining the prospective use of an IV TXA protocol for the management of PTH in pediatric patients. We found that protocol implementation significantly reduced the need to return to the OR for PTH, minimizing patient morbidity without notable complications and improving value-based care.

    Presenting Author(s)

  • Laura A. Petrauskas, MD

    Assistant Professor
    Louisiana State University Health Sciences Center
    New Orleans, LA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Rahul Kamal Sharma, MD

    Resident Physician
    Vanderbilt University Medical Ctr
    Nashville, Tennessee, United States

    Disclosure information not submitted.

  • Christopher T. Wootten, MD, MMHC

    Professor, Department of Otolaryngology--Head and Neck Surgery
    Vanderbilt University Medical Center
    Nashville, TN, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • James D. Phillips, MD

    Associate Professor
    Vanderbilt University
    Brentwood, Tennessee, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Ryan H. Belcher, MD, MPH

    Associate Professor, Vanderbilt Division of Pediatric Otolaryngology - HNS
    Vanderbilt University
    Nashville, TN, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • AW

    Amy S. Whigham, MD, MS-HPEd

    Associate Professor
    Vanderbilt University
    Nashville, Tennessee, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • JW

    Jay a. Werkhaven, MD

    professor
    Vanderbilt University medical center
    nashville, TN, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Lyndy J. Wilcox, MD, MMHC

    Associate Professor
    Vanderbilt University
    Nashville, TN, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • FV

    Frank W. Virgin, MD

    Professor
    Vanderbilt University Medical Center
    Nashville, TN, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Senior Author(s)

  • JP

    Jason S. Park, MD, PhD

    Assistant Professor
    Vanderbilt University
    Nashville, TN, United States

    Disclosure information not submitted.