Presenter Status
Medical Student
Abstract Type
QI Project
Primary Mentor or Principal Investigator
Elie Khalifee, MD
Presentation Type
Poster-Restricted Access
Start Date
21-5-2026 11:00 AM
End Date
21-5-2026 12:00 PM
Abstract Text
Problem Statement/Question: Will a standardized nebulized TXA protocol reduce the need for surgical control of post-tonsillectomy hemorrhage without increasing adverse clinical outcomes?
Background/Project Intent (Aim Statement): Emerging evidence suggests that tranexamic acid (TXA), a widely used antifibrinolytic agent, may be effective in the management of post-tonsillectomy hemorrhage (PTH). We hypothesized that initiation of a standardized nebulized TXA protocol would reduce the need for surgical control of bleeding without increasing adverse clinical outcomes.
Methods (include PDSA cycles): This quality improvement (QI) project included patients < 18 who underwent extracapsular tonsillectomy and subsequently presented with PTH. Three cohorts were analyzed: a pre-intervention group (January 2020-June 2022), a non-standardized TXA phase following departmental review of emerging evidence (PDSA cycle 1; July 2022- December 2023), and a standardized nebulized TXA protocol phase (PDSA cycle 2; January 2024-July 2025). The primary outcome was surgical intervention for PTH. Balancing measures included hospital length of stay, blood product transfusions, 30-day readmissions, and TXA-attributable complications. Data was analyzed using statistical process control methods.
Results: A total of 501 patients were included (median age 7.2 years). Rates of surgical control decreased sequentially across the three phases (43.9% vs. 29.8% vs. 15.2%, P< 0.0001). No differences were observed in hospital length of stay, transfusion rates, readmissions, or TXA-attributable complications.
Conclusions: Implementation of a standardized nebulized TXA protocol was associated with a 65.4% relative reduction in surgical intervention for PTH, without evidence of unintended harm. Nebulized TXA may be safely incorporated as a first-line, standardized intervention for pediatric PTH, with potential to reduce operative burden and resource utilization without compromising patient safety.
Implementation of a Nebulized Tranexamic Acid Protocol for Pediatric Post-Tonsillectomy Hemorrhage: A Quality Improvement Initiative
Problem Statement/Question: Will a standardized nebulized TXA protocol reduce the need for surgical control of post-tonsillectomy hemorrhage without increasing adverse clinical outcomes?
Background/Project Intent (Aim Statement): Emerging evidence suggests that tranexamic acid (TXA), a widely used antifibrinolytic agent, may be effective in the management of post-tonsillectomy hemorrhage (PTH). We hypothesized that initiation of a standardized nebulized TXA protocol would reduce the need for surgical control of bleeding without increasing adverse clinical outcomes.
Methods (include PDSA cycles): This quality improvement (QI) project included patients < 18 who underwent extracapsular tonsillectomy and subsequently presented with PTH. Three cohorts were analyzed: a pre-intervention group (January 2020-June 2022), a non-standardized TXA phase following departmental review of emerging evidence (PDSA cycle 1; July 2022- December 2023), and a standardized nebulized TXA protocol phase (PDSA cycle 2; January 2024-July 2025). The primary outcome was surgical intervention for PTH. Balancing measures included hospital length of stay, blood product transfusions, 30-day readmissions, and TXA-attributable complications. Data was analyzed using statistical process control methods.
Results: A total of 501 patients were included (median age 7.2 years). Rates of surgical control decreased sequentially across the three phases (43.9% vs. 29.8% vs. 15.2%, P< 0.0001). No differences were observed in hospital length of stay, transfusion rates, readmissions, or TXA-attributable complications.
Conclusions: Implementation of a standardized nebulized TXA protocol was associated with a 65.4% relative reduction in surgical intervention for PTH, without evidence of unintended harm. Nebulized TXA may be safely incorporated as a first-line, standardized intervention for pediatric PTH, with potential to reduce operative burden and resource utilization without compromising patient safety.
Comments
Poster Board Number: 31