Improving Perioperative Tranexamic Acid Administration in Hip Fracture Surgery - A Two-Cycle Quality Improvement Project at Dorset County Hospital

Sep 28, 2026

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Tranexamic acid (TXA) is used to reduce bleeding by inhibiting fibrinolysis, yet uptake in hip fracture surgery varies between institutions. This two-cycle quality improvement project at Dorset County Hospital evaluated perioperative TXA administration in patients aged 65 and over undergoing surgical management of hip fractures. After targeted interventions and improved adherence to updated local protocols, TXA use increased from 70% to 85.2%. Clear local guidelines and rigorous documentation of contraindications improved consistency of perioperative care.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Introduction

Review began 11/14/2025 Review ended 11/27/2025 Published 12/01/2025 © Copyright 2025 Mahmoud et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98220 Open Access Original Article Improving Perioperative Tranexamic Acid Administration in Hip Fracture Surgery: A TwoCycle Quality Improvement Project at Dorset County Hospital Mohamed E. Mahmoud 1, Qamar Mustafa 1, Owen Mitchell 1 1. Trauma and Orthopaedics, Dorset County Hospital NHS Foundation Trust, Dorchester, GBR Corresponding author: Mohamed E. Mahmoud, [mohamed.essam.neo@gmail.com](mohamed.essam.neo@gmail.com) Abstract Background Tranexamic acid (TXA) is widely used in surgical practice to reduce bleeding by inhibiting fibrinolysis. Despite its established role, utilisation in hip fracture surgery varies across institutions. This quality improvement project evaluated perioperative TXA administration within a district general hospital and assessed the impact of targeted interventions on prescribing practices. Methods A quality improvement project was initiated at Dorset County Hospital (DCH), Dorchester, England, to evaluate the utilisation of TXA in patients admitted with hip fractures that were surgically treated. All patients aged 65 and over undergoing surgical management of hip fractures were included, excluding those with contraindications (recent thromboembolic events, active clotting disorders, hypersensitivity, or recent stenting) . Two audit cycles were conducted, i.e., September-November 2021 and September-October 2023, assessing perioperative TXA administration rates. Results TXA use increased from 70%(n = 37) in the first cycle to 85.2%(n = 27) in the second cycle. Improved uptake correlated with enhanced staff awareness and adherence to updated local protocols. Conclusion Implementing clear local guidelines and ensuring documentation of contraindications significantly improved TXA administration in hip fracture surgery. These measures supported more consistent practice and contributed to an overall improvement in perioperative care within the department. Categories: Hematology, Trauma, Orthopedics Keywords: fragility hip fracture, perioperative blood loss, perioperative medicine, quality improvement research, tranexamic acid (txa) Introduction Hip fractures are one of the most common orthopaedic presentations in the United Kingdom, with over 70,000 cases annually [1,2] . They carry a one-year mortality of around 30% and a substantial burden on patients, families, and health systems [3] . This high incidence highlights the critical need for effective interventions to optimize perioperative care and minimize complications such as perioperative anaemia and prolonged admissions that are associated with these procedures. While surgical intervention is the mainstay of treatment, perioperative bleeding remains a major challenge. Both visible and hidden blood loss can exceed one litre, often leading to perioperative anaemia and high rates of allogeneic red blood cell transfusion [4] . Transfusion, while sometimes lifesaving, is associated with longer hospital stay, infection risk, immunological complications, and increased costs, particularly in frail older adults [5] . Tranexamic acid (TXA) is a low-cost antifibrinolytic agent with a proven ability to reduce surgical bleeding by stabilising fibrin clots. It works by inhibiting the activation of plasminogen to plasmin, thus preventing the breakdown of fibrin [6] . This mechanism is particularly beneficial in hip fracture surgeries, where maintaining hemostasis is crucial for optimal recovery and minimizing complications [2] . Its efficacy and safety profile are well documented across trauma, obstetrics, and elective orthopaedic surgery [7] . Im

FAQs

What problem did the quality improvement project address?

TXA is widely recommended to reduce surgical bleeding, but real-world use in hip fracture surgery was inconsistent across institutions. The project targeted improved perioperative prescribing at Dorset County Hospital.

How were the patients selected for the audits?

All patients aged 65 and over undergoing surgical management of hip fractures were included, except those with contraindications such as recent thromboembolic events, active clotting disorders, hypersensitivity, or recent stenting.

What were the results after the interventions?

TXA administration increased from 70% in the first audit cycle to 85.2% in the second cycle. The improvement was associated with better staff awareness and adherence to updated local protocols.

Sep 28, 2026

Uploaded by Kurz