Comparison of the efficacy of hot saline irrigation and tranexamic acid on Boezaart score, intraoperative blood loss, and duration of surgery in functional endoscopic sinus surgery: a systematic review and meta-analysis

Timmy Wibisono; Budi Sutikno; Titiek Hidayati  Ahadiah; Budi  Utomo; Citrawati Dyah  Kenconowungu

doi:10.15562/bmj.v12i2.4362

Comparison of the efficacy of hot saline irrigation and tranexamic acid on Boezaart score, intraoperative blood loss, and duration of surgery in functional endoscopic sinus surgery: a systematic review and meta-analysis

Timmy Wibisono ,

Budi Sutikno ,

Titiek Hidayati Ahadiah ,

Budi Utomo ,

Citrawati Dyah Kenconowungu ,

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DOI: https://doi.org/10.15562/bmj.v12i2.4362 |
Published: 2023-05-01

Abstract

Link of Video Abstract: https://youtu.be/wEp6PioGVqw

Background: Hot saline irrigation and tranexamic acid are techniques used to control bleeding during functional endoscopic sinus surgery (FESS). Hot saline irrigation and tranexamic acid can help control bleeding originating from microvascular located in the nasal cavity and paranasal sinuses. This study aims to compare the efficacy of these two techniques on Boezaart score, intraoperative blood loss, and duration of surgery in functional endoscopic sinus surgery.

Methods: This study is an intervention meta-analysis, the research formulated based on the population, intervention, comparison, outcome, and study design (PICOS). Articles were searched from five databases, including PubMed Central and publisher websites, Cochrane Library, ResearchGate, SAGE Journals, and Web of Science. There were no publication year or publication status restrictions on the selected research articles, and the date of the last search was up to February 2023. The efficacy of hot saline irrigation as a bleeding control method compared to tranexamic acid was assessed based on Boezaart surgical field score, intraoperative bleeding, and duration of surgery in functional endoscopic sinus surgery (FESS).

Results: A total of 532 research articles were identified, and fifteen articles that met the inclusion and exclusion criteria were selected. Hot saline irrigation p-value p=0.0002 and for tranexamic acid p=<0.00001 based on Boezaart score. Hot saline irrigation p= 0.0001 and tranexamic acid had a p= 0.0002 based on the Intraoperative blood loss, but the standardized mean difference in the hot saline irrigation group was smaller compared to the tranexamic acid topical group. Hot saline irrigation p=0.06 and tranexamic acid p=0.13 for duration of surgery.

Conclusion: This meta-analysis showed that the administration of tranexamic acid or hot saline irrigation could significantly reduce duration of surgery, intraoperative blood loss and improved surgical feld quality compared with room temperature saline irrigation. There is no statistically significant difference between tranexamic acid topical and hot saline irrigation.

References

Gabriella CC, Wigati KW, Sutikno B. Correlation between the severity of chronic rhinosinusitis and sleep quality in adult patients. Biomol Heal Sci J. 2020;3(2):62.
Wormald PJ. Setup and ergonomics of endoscopic sinus surgery. In (Hiscock T, ed). Endoscopic Sinus Surgery. 4th edition, New York: Thieme, 2018;pp.1-5.
Hakim ML, Kristyono I. Chronic rhinosinusitis patient with nasal polyps at Dr. Soetomo General Academic Hospital Center. Bali Medical Journal. 2022;11(2): 766-770.
Stankiewicz JA, Lal D, Connor M, et al. Complications in endoscopic sinus surgery for chronic rhinosinusitis: a 25-year experience. Laryngoscope. 2011;121(12):2684–701.
Sutikno B, Fauzi F, Ardani DM, Mailasari A. Differences in the length of postoperative care of endoscopic endonasal surgery in simple and complex surgical procedure groups. F1000Research. 2022;11:619.
Valentine R, Wormald P. A vascular catastrophe during endonasal surgery: an endoscopic sheep model. Skull Base. 2011;21(02):109–114.
Gan EC, Alsaleh S, Manji J, Habib AR, Amanian A, Javer AR. Hemostatic effect of hot saline irrigation during functional endoscopic sinus surgery: a randomized controlled trial. Int Forum Allergy Rhinol. 2014;4(11):877-84.
Shehata A, Ibrahim MS, El-Fattah MHA. Topical tranexamic acid versus hot saline for field quality during endoscopic sinus surgery. The Egyptian Journal of Otolaryngology. 2014;30:327-31.
Clarke M, Horton R. Bringing it all together: Lancet–Cochrane collaborate on systematic reviews. Lancet. 2001;357:1728.
Acion L, Peterson JJ, Temple S, Arndt S. Probabilistic index: an intuitive non-parametric approach to measuring the size of treatment effects. Stat Med. 2006;25:591–602.
Hwang SH, Lee HS, Joo YH, Seo JH, Kang JM. Efficacy of dexmedetomidine on perioperative morbidity during nasal surgery: A meta-analysis. Laryngoscope. 2018;128:573–580.
Jabalameli M, Zakeri K. Evaluation of topical tranexamic acid on intraoperative bleeding in endoscopic sinus surgery. Iran J Med Sci. 2006;31: 221-23.
Athanasiadis T, Beule AG, Wormald PJ. Effects of topical antifibrinolytics in endoscopic sinus surgery: a pilot randomized controlled trial. Am J Rhinol. 2007;21:737-42.
Alimian M, Mohseni M. The effect of intravenous tranexamic acid on blood loss and surgical field quality during endoscopic sinus surgery: a placebo-controlled clinical trial. J Clin Anest. 2011;23: 611-15.
Langille MA, Chiarella A, Côté DW. Intravenous tranexamic acid and intraoperative visualization during functional endoscopic sinus surgery: a double-blind randomized controlled trial. Int Forum Allergy Rhinol. 2013;3:315-18.
Jahanshahi J, Hashemian F, Pazira S, Bakhshaei MH, Farahani F, Abasi R, et al. Effect of topical tranexamic acid on bleeding and quality of surgical field during functional endoscopic sinus surgery in patients with chronic rhinosinusitis: a triple blind randomized clinical trial. PloS One. 2014;9(8):1-6.
El Shal S, Hasanein R. Effect of intravenous tranexamic acid and epsilon aminocaproic acid on bleeding and surgical field quality during functional endoscopic sinus surgery (FESS). Egypt J 2015;31:1–7.
Nuhi S, Goljanian Tabrizi A, Zarkhah L, Rashedi Ashrafi B. Impact of intravenous tranexamic acid on hemorrhage during endoscopic sinus surgery. Iran J Otorhinolaryngol. 2015;27:349-54.
Al-Ississ A, Al-Khaldi H, Maayah A, Kilani NK. Effect of warm saline on bleeding during sinus and septum surgery. Journal of The Royal Medical Services. 2016;23:17-21.
Dongare D H, Saundattikar G Y. Comparison of intraoperative bleeding and surgical fields with and without tranexamic acid in functional endoscopic sinus surgery. Indian J Clin Anaesth. 2018;5(2):233-36.
Padhy PK, Narayanaswamy R. Impact of intravenous tranexamic acid on intraoperative bleeding during endoscopic sinus surgery. Bengal Journal of Otolaryngology and Head Neck Surgery. 2019;27(3):198–203.
Pannerselvam TA, Kumar KVR, Karthekeyan RB. Comparative study of two different intravenous doses of tranexamic acid with placebo on surgical field quality in functional endoscopic sinus surgery-a randomised clinical trial. J Clin Diagnostic Res. 2019;5–9.
El-Ozairy HSED, Mady OM, Tawfik GM, Elhennawy AM, Teaima AA, Ebied A, et al. Outcomes of combined use of topical and intravenous tranexamic acid on surgical field quality during functional endoscopic sinus surgery: randomized controlled trial. Head Neck. 2021;43(5):1389–97.
Yang W, Gou H, Li H, Liu Y, Wan Y, Wang C, et al. Intravenous tranexamic acid improves the intraoperative visualization of endoscopic sinus surgery for high-grade chronic rhinosinusitis: a randomized, controlled, double-blinded prospective trial. Front Surg. 2021;8:1–7.
Mc Elligott E, Quigley C, Hanks GW. Tranexamic acid and rectal bleeding. Lancet. 1991;337: 431.
Utomo DN, Wardhana TH, Amrullah AH, Hamzah H. The effect of tranexamic acid injection on hemoglobin level, albumin level, and pain on patient receiving total knee replacement. J Orthop Traumatol Surabaya. 2019;8(1):1.
Gill JB, Rosenstein A. The use of antifibrinolytic agents in total hip arthroplasty: a meta-analysis. J Arthroplasty. 2006;21:869-73.
Wedari NLPH, Sukrama IDM, Budayanti NNS, Sindhughosa DA, Prabawa IPY, Manuaba IBAP. One Health concept and role of animal reservoir in avian influenza: a literature review. Bali Medical Journal. 2021;10(2):515-520.
Yuliyani EA, Sutanegara SWD, Muliartha IM. Effectiveness of nasal irrigation with isotonic saline against interleukin-8 levels and quality of life in chronic rhinosinusitis patients. Bali Medical Journal. 2019:8(3):750-754.
Weber RK, Hosemann W, 2015. Comprehensive review on endonasal endoscopic sinus surgery. GMS Curr Top Otorhinolaryngol Head Neck Surg 22:14.