The Effect of Tranexamic Acid on Estimated Blood Loss and Transfusion Rates in Children with Cerebral Palsy Undergoing Single-Event Multi-Level Surgery, a Retrospective Study

Purpose: Multiple osteotomies are frequently associated with single-event multi-level surgery (SEMLS) in children with cerebral palsy (CP). However, appropriate management of perioperative blood loss is crucial for decreasing the length of hospital stay and early rehabilitation. Tranexamic acid (TxA) has been proven to significantly reduce perioperative bleeding in multiple major orthopedic surgeries. The aim of this study was to investigate the effectiveness of TxA in decreasing blood loss in children with CP undergoing SEMLS procedures. Materials and Methods: Between September 2016 and September 2022, 101 consecutive children with CP who underwent SEMLS were identified-50 patients did not receive TxA peri-operatively (Control Group, from September 2016 to September 2018), and 51 patients received TxA (TxA Group since September 2018). Bleeding, hemoglobin levels, transfusion rate, length of hospital stay and postoperative hematocrit were compared between the groups. The predictive factors of blood transfusion were determined. Results: The transfusion rate significantly decreased in the TxA Group (43.3% vs. 4%, p < 0.001). The use of TxA and epidural analgesia were the identified factors for a significant transfusion rate decrease. Bleeding (estimated red cell loss) was decreased in the TxA group in comparison to the control group 22.3 [17.3-27.3] versus 33.78 [27.4-40.2], p < 0.05). The hospital length of stay significantly decreased in the TxA group (7.3 vs. 6 days, p = 0.01). No TxA-related complications occurred in any of the patients. Conclusions: A blood loss prevention strategy based on a low dose of TxA in children scheduled for SEMLS significantly decreased bleeding and transfusion rates, allowing an earlier discharge from the hospital for patients.