Design: Retrospective cohort study at a single institution using a database of all hysterectomies over a 1 year period from 2020-2021 created using procedure codes for laparoscopic, robotic assisted, and vaginal hysterectomy.

Setting: A community based tertiary care hospital.

Patients or Participants: 1152 patients undergoing hysterectomies for both benign and oncologic indications were performed over the study year. 62 patients met inclusion criteria in the treatment arm and 62 patients were matched by age, BMI, race, and starting hemoglobin level for a total of 124 patients.

Interventions: Treatment arm received intraoperative TXA; the matched cohort did not.

Measurements and Main Results: The primary outcome studied was the incidence of transfusion within 30 days of surgery amongst patients who did vs. did not receive TXA at the time of surgery. Secondary outcomes included readmission rates, length of hospital stay, and estimated blood loss. Baseline characteristics between the treatment and control groups were well matched. There was no significant difference in transfusion with 25.8% of the treatment arm receiving blood vs. 33.9% in the control arm (95% CI 0.68-3.19, P=0.33). TXA administration was associated with a higher median estimated blood loss (400 mL in treatment vs. 300 mL in control, P=0.002). No differences were seen between groups with regards to operative time, or length of hospital stay. Independent factors significantly associated with transfusion were preoperative hemoglobin of <9 and public insurance.

Conclusion: Intraoperative TXA was associated with a modest increase in estimated blood loss, but was not associated with a significant difference in the rate of blood transfusion. This likely reflects surgeon preferences in managing increases in subjective blood loss. Prospective studies are necessary for standardization.