Implementation of a Nebulized Tranexamic Acid Protocol for Pediatric Post-Tonsillectomy Hemorrhage: A Quality Improvement Initiative.
Document Type
Article
Publication Date
9-2026
Identifier
DOI: 10.1002/ohn.70341; PMCID: PMC13525887
Abstract
OBJECTIVE: We hypothesized that initiation of a standardized nebulized TXA protocol for posttonsillectomy hemorrhage (PTH) would reduce the need for surgical control of bleeding without increasing adverse clinical outcomes.
METHODS: This quality improvement project included patients under 18 years of age who presented with PTH. Preintervention data were collected between January 1, 2020, and June 30, 2022. Plan-Do-Study-Act (PDSA) cycle 1, between July 1, 2022, and December 31, 2023, included patients who received nebulized TXA without a standardized protocol, based on emerging evidence supporting its use in PTH. PDSA cycle 2, between January 1, 2024, and July 13, 2025, followed the implementation of a standardized TXA protocol. Data included need for surgical control of bleeding, length of stay, transfusions, readmissions, and TXA-related complications.
RESULTS: A total of 501 patients were included, with a median age of 7.2 years, distributed across the preintervention group (n = 171), PDSA 1 (n = 205), and PDSA 2 (n = 125). The proportion of patients requiring surgical control of bleeding decreased with each intervention (43.9% vs 29.8% vs 15.2%, P < .0001). There were no changes in the length of stay, transfusion rates, readmissions, or TXA-related complications.
DISCUSSION: Across 2 PDSA cycles, we achieved a 65.4% reduction in the need for surgical control of bleeding for PTH without an increase in balancing measures, used as surrogates for unintended consequences of the interventions.
IMPLICATIONS FOR PRACTICE: Implementation of a nebulized TXA protocol may be a safe and effective management option for PTH.
Journal Title
Otolaryngology and head and neck surgery
Volume
175
Issue
3
First Page
721
Last Page
732
MeSH Keywords
Humans; Tranexamic Acid; Tonsillectomy; Postoperative Hemorrhage; Antifibrinolytic Agents; Female; Child; Quality Improvement; Male; Nebulizers and Vaporizers; Child, Preschool; Adolescent; Administration, Inhalation; Clinical Protocols; Length of Stay
PubMed ID
42466952
Keywords
PS/QI; pediatric otolaryngology; post‐tonsillectomy hemorrhage; tonsillectomy; tranexamic acid
Recommended Citation
Singerman KW, Nguyen A, Welker B, et al. Implementation of a Nebulized Tranexamic Acid Protocol for Pediatric Post-Tonsillectomy Hemorrhage: A Quality Improvement Initiative. Otolaryngol Head Neck Surg. 2026;175(3):721-732. doi:10.1002/ohn.70341
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