Tranexamic acid reduces transfusion requirements after pelvic osteotomy: a nationwide propensity score-matched analysis

Pelvic osteotomy is frequently associated with substantial perioperative blood loss due to the highly vascularized pelvic anatomy. Tranexamic acid (TXA) is widely used to reduce blood loss in total hip arthroplasty; however, evidence supporting its use in pelvic osteotomy, particularly in Asian populations, remains limited. This study evaluated the association between perioperative TXA use, transfusion requirements, and postoperative complications in patients undergoing pelvic osteotomy in Japan. Using the Japanese Diagnosis Procedure Combination nationwide administrative database, we retrospectively identified patients who underwent pelvic osteotomy between December 2011 and March 2023. Patients receiving perioperative TXA were compared with those who did not, using one-to-one propensity score matching. Outcomes included transfusion rates on postoperative days 0–2, cumulative transfusion volume, and in-hospital complications, including infection, deep vein thrombosis, pulmonary embolism (PE), and reoperation. After matching, 3,542 patients were included in each group. TXA use was independently associated with a significantly lower likelihood of blood transfusion on postoperative days 0 (95% CI, 0.552–0.693; p < 0.05) and 1 (95% CI, 0.472–0.579; p < 0.05). The cumulative transfusion volume over the first three postoperative days was significantly lower in the TXA group than in the non-TXA group (598.8 ± 408.0 g vs. 728.6 ± 426.5 g; p < 0.05). While autologous transfusion use differed, allogeneic transfusion rates were comparable. Subgroup analysis demonstrated that this reduction in overall transfusion was primarily attributable to a significantly lower utilization of autologous blood transfusion, whereas allogeneic transfusion rates were comparable between the groups. No significant increase in infection, PE, or reoperation was observed. Perioperative TXA use was associated with reduced transfusion requirements after pelvic osteotomy without compromising short-term safety, supporting its use within contemporary perioperative management in Japan.