Reducing postoperative morbidity by diminishing chest tube drainage utilizing tranexamic acid following vertebral body tethering for adolescent idiopathic scoliosis.

Abstract

Purpose: Vertebral body tethering (VBT) is a non-fusion surgical option for adolescent idiopathic scoliosis (AIS) that requires a postoperative (PO) chest tube. This study evaluates whether 48 h of PO TXA reduces chest tube (CT) drainage and retention compared to 24 h of TXA following VBT for AIS.

Methods: Consecutively treated patients with a diagnosis of AIS who underwent VBT were assessed. Thirty-eight patients who received 48 h of PO IV TXA (48-TXA) were compared to 35 VBT patients who received 24 h of PO IV TXA (24-TXA) and 48 patients who did not receive TXA (non-TXA). TXA use in thoracic CT and thoracolumbar CT drainages were also assessed separately. Group comparisons were performed using one-way ANOVA and Chi-square tests.

Results: There were no significant differences in demographics between groups. TXA significantly reduced CT drainage (p < 0.001) and retention (p < 0.001), with no differences between 24-TXA and 48-TXA (p = 0.88). Sub-analyses showed that both 24-TXA and 48-TXA reduced thoracic CT drainage (p = 0.002, p = 0.02) and retention time (p = 0.04, p = 0.007) compared to non-TXA, respectively. For thoracolumbar CT, differences were observed only between 24-TXA and non-TXA (p = 0.01, p = 0.03). TXA was an independent predictor of reduced CT drainage (p < 0.001) and retention (p < 0.001). Hospital stay, ICU stay, and complications didn't differ between TXA groups (p > 0.9, p = 0.4), respectively.

Conclusions: Intravenous TXA reduces CT drainage and retention after VBT for AIS for thoracic CTs. There was no additional benefit of 48-TXA over 24-TXA in decreasing overall drainage and CT retention time.