HPB SO67 - An audit to improve the perioperative administration of tranexamic acid (TXA) to reduce the need for peri- and post-operative blood transfusion in major HPB resections

Abstract Background NHS Blood and Transplant (NHSBT) triggered an ‘amber alert’ on 12 October 2022, meaning hospitals have been asked to put in place management plans to protect blood stocks. In line with these measures requested by NHSBT, The Royal College of Surgeons of England recommended using tranexamic acid in all adult surgical patients if more than 500ml of blood loss is likely. Results from the recent POISE-3 clinical trial confirm the quality, safety and cost-effectiveness of tranexamic acid in surgery, where more than 500ml of blood loss is anticipated. Method Patients were identified by searching the Sheffield Teaching Hospital (STH) operation note database using the key words: hepatectomy, pancreatectomy, liver resection, PPPD and pancreaticoduodenectomy. Retrospective case note review identified TXA administration, pre and postoperative haemoglobin level and blood transfusion prescription. Results 49 patients undergoing major HPB resection at Sheffield Teaching Hospitals (STH) from October 2022 to March 2023 were identified. Following the addition of a prompt in the WHO timeout pre-op checklist, a further 24 patients were reviewed. The audit compared the number of patients who received TXA, pre- and post-operative haemoglobin levels and incidence of intra- or postoperative blood transfusion (within 30 days) between the two groups. Including a prompt did not increase the likelihood of a pre-operative dose of TXA being administered. Mean change in haemoglobin and the proportion of patients requiring transfusion remained similar between the two groups. Conclusion Incorporating a preoperative prompt in the WHO timeout checklist did not improve adherence to guidelines for TXA administration in major HPB surgery. Future audits should continue monitoring these trends and investigating further strategies to optimise perioperative blood management. However, there are randomised controlled trials comparing TXA with placebo in liver resection and the recent TAC-PD trial showed that perioperative TXA did not reduce blood loss in pancreaticoduodenectomy.