Cost efficiency of topical tranexamic acid in reduction mammaplasty surgeries

BACKGROUND AND AIMS: Perioperatively used, topically administered tranexamic acid (TXA) has attracted increasing interest in plastic surgery, and several studies have compared the effectiveness and safety of topical and intravenous (IV) administration. Topical TXA has been reported to have an equal or superior effect in reducing postoperative bleeding and transfusion requirements, with no increase in reported adverse events. Although prophylactic topical TXA is believed to result in cost savings, cost-effectiveness analyses concerning the use of TXA in breast surgery have not yet been reported. METHODS: This single-center, retrospective cohort study calculated the costs for all patients who underwent reduction mammaplasty between 2019 and 2021 at Jorvi Hospital, Finland. We compared postoperative complications and total healthcare costs associated with surgery between two groups: patients who received topical TXA perioperatively (TXA group) and patients who did not receive TXA (non-TXA group). Total costs were analyzed, including both the intraoperative and postoperative periods. All costs were calculated in euros, based on the 2020 Helsinki University Hospital (HUS) rates. RESULTS: In 328 breast reduction surgeries, the leading postoperative costs were caused by reoperations, and additional ward stays due to complications. The cost of TXA irrigation itself was negligible compared with the other expenses. The median postoperative costs were €414 in the non-TXA group and €335 in the TXA group, and the mean postoperative costs were €874 in the non-TXA group and €453 in the TXA group (p = 0.002). In the non-TXA group, 11 patients (6.1%) underwent reoperation for hematoma and four (2.2%) for other wound-healing complications. In contrast, in the TXA group only one (0.7%) patient required reoperation for hematoma and one (0.7%) for wound-healing complications. CONCLUSION: This study demonstrates that the application of this low-cost drug may reduce the overall costs associated with reduction mammaplasty.