A Trial of a Hospital Policy of Tranexamic Acid Use to Reduce Transfusion in Major Non-cardiac Surgery

Inclusion Criteria

• •Hospital sites will be included in the trial if the site performs ≥ 100 noncardiac surgeries per month, and if anesthesia, surgery and hospital leadership agree to manage patients as per the policy being implemented and evaluated in the trial.
• •Patients \>/= 18 years of age undergoing major non-cardiac surgery (a state of hyperfibrinolysis)
• •Inpatient surgeries with an estimated \>/= 5% risk of RBC transfusion, including open surgeries or laparoscopic surgeries with an estimated duration of \>/= 3 hours
• •Examples of eligible surgeries could include (but are not limited to):
• •1. General surgery (esophagectomy, gastrectomy, gastric repair, small bowel repair or resection, ostomy formation, colon/rectum repair or resection, colostomy, splenectomy, hepatectomy, pancreatectomy, resection of abdominal mass)
• •2. Orthopedics (hip fracture repair, pelvic fixation, femur repair / fixation, shoulder / humerus open reduction internal fixation, lower extremity amputation)
• •3. Spine (vertebrectomy, surgery involving \>/= 3 levels)
• •4. Otolaryngology (glossectomy, mandibulectomy, radical laryngectomy)
• •5. Thoracic (lung resection or decortication)
• •6. Vascular (arterial bypass / endarterectomy / aneurysmorrhaphy involving the aorta or proximal vessels off the aorta)
• •7. Gynecology (hysterectomy)
• •8. Urology (nephrectomy, cystectomy, prostatectomy, pelvic exenteration)
• •9. Plastic surgery (large neoplasm resections, burns or debridements)
• •10. Surgeries anticipated to be associated with 5% or greater risk of RBC transfusion in hospital as per the surgical team.