Methods: Retrospective cohort study. Objective: To assess the efficacy of tranexamic acid (TXA) on reducing perioperative blood loss and blood transfusion requirements in nonidiopathic scoliosis patients undergoing primary posterior spinal fusion.

Background: Posterior spinal fusion for correcting scoliosis in pediatric patients is associated with substantial volumes of perioperative blood loss and high transfusion requirements. Patients with nonidiopathic scoliosis typically experience greater blood loss than those with idiopathic scoliosis.

Methods: We retrospectively reviewed patients who underwent primary posterior fusion for nonidiopathic scoliosis between November 2014 and December 2020. Patients were assigned to the TXA or no-TXA group depending on intraoperative administration of TXA.

Results: Despite longer surgical duration (P=0.009) and more spinal levels fused (P=0.014), perioperative blood loss [2602 (810-9262) mL in the TXA group vs. 2058 (1019-4170) mL in the no-TXA group, P=0.554] and allogenic red blood cell transfusion rates (63% in the TXA group vs. 55% in the no-TXA group, P=0.508) were similar in the TXA and the no-TXA groups. After adjustments, TXA administration was found to have a significant negative effect on estimated blood loss (Est=-513.73, 95% CI=-925.41 to 125.3, P=0.045).

Conclusions: Significant perioperative blood loss and high transfusion rates remain a challenge in the surgical treatment of nonidiopathic scoliosis patients. Given the demonstrated negative effect of TXA on estimated blood loss, its routine application may be considered in the perioperative blood management of pediatric nonidiopathic scoliosis patients. Methods: Level III.