The effect of antifibrinolytic agents in periacetabular osteotomy: A systematic review and meta-analysis

Background: Periacetabular osteotomy (PAO) is a major hip preservation surgery for developmental dysplasia of the hip. It is inevitably associated with significant blood loss, so it requires frequent transfusions and could be a cause of perioperative morbidity. However, to date, a large number of studies has not evaluated the effect of antifibrinolytic agents in PAO. Therefore we performed a systematic review and meta-analysis to assess if antifibrinolytics would be effective in reducing blood loss and transfusion rate after PAO surgery. Methods: In this systematic review and meta-analysis, MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before April 4, 2020, that investigated the effect of antifibrinolytic agents in PAO. A pooled analysis was designed to identify differences between antifibrinolytic and control groups focusing on blood loss, transfusion, operation time, postoperative venous thromboembolism (VTE), and length of hospital stay. Results: We included five studies involving 507 patients (antifibrinolytic group: 256; control group: 251). The pooled analysis showed that the control group had a greater total estimated blood loss (EBL) than the antifibrinolytic group (mean difference [MD] = -257.60 mL, 95% confidence interval [CI] -389.68 to -125.53, p = 0.0001), but there were no statistical differences in intraoperative EBL (MD = -46.46 mL, 95% CI: -192.57 to 99.64, p = 0.53). The allogenic transfusion rate was higher in the control group than in the antifibrinolytic group (odds ratio [OR] 0.21, 95% CI: 0.10-0.43, p < 0.0001), but there was no difference in the autogenic transfusion rate (OR 0.35, 95% CI: 0.09-1.43, p = 0.14). The pooled result showed no difference in operation time (MD = 9.13 min, 95% CI: -8.54 to 26.80, p = 0.31). For the VTE rate, a pooled analysis was not conducted due to the lack of data. The length of hospital stay showed no differences (MD = -0.51 days, 95% CI: -1.17 to 0.16, p = 0.13). Conclusions: Antifibrinolytic use in PAO has positive effects in terms of reduced total EBL and allogenic transfusion rate. Level of evidence: III; meta-analysis. (C) 2022 Elsevier Masson SAS. All rights reserved.