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Introduction: Airborne Biologic Particles (ABPs) are a potential risk factor for infection following total joint arthroplasty. Factors such as temperature and humidity may affect the number of ABPs which can increase the risk of infection. Comparisons of ABP count between Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) have yet to be made. Our study examines the differences in ABP count between primary THA and TKA procedures. Methods: We analyzed all primary TJA procedures done within the same OR at an academic institution from April 2019 to June 2020. All procedures between the dates of March 15, 2020 – May 4, 2020 were excluded to avoid COVID-related confounding. Intraoperative measurements of temperature, humidity, and ABP count per minute were recorded. A report containing surgical data from the same time was generated using the institution’s Electronic Health Records (EHR) system and cross-referenced to the intraoperative measurements using procedure start and end times. ABP was calculated as an average ABP count per minute. Descriptive statistics were used to evaluate differences in variables of interest. P-values were calculated using t-test for continuous variables and chi square for categorical values. Results: A total of 168 cases were included in the study, comprised of 98 (58.3%) primary THA and 70 (41.7%) primary TKA. No significant differences in room temperature or particle counts across all particle sizes were found between THA and TKA groups. Similarly, time spent in the room was not significantly different between THA and TKA. The only variable that was significantly different between the two groups was average relative humidity, with higher humidity in the THA group (46.9% + 7.56 vs 44.4% + 8.02, p=0.008). Conclusion: There were no significant differences in temperature or particle count between primary THA and primary TKA procedures, suggesting OR air quality was similar between the two procedure types. Further investigation including additional variables such as OR size, airflow patterns, and different procedure types should be performed to better characterize the role of ABPs in air quality and infection risk.

BACKGROUND CONTEXT Current literature demonstrates that tranexamic acid (TXA) use during spine surgery is safe and effective at reducing intraoperative blood loss and need for blood transfusion. TXA use is increasing and it is now being used in both major and minor spine procedures. Literature comparing the use of topical TXA and intravenous (IV) TXA in reducing blood loss and transfusion rates in elective lumbar spine procedures is scarce. PURPOSE This study aimed to compare the efficacy of topical and IV TXA in reducing intraoperative and postoperative blood loss in adult patients undergoing elective lumbar spine surgery. STUDY DESIGN/SETTING Prospective randomized controlled trial at a single tertiary academic center. PATIENT SAMPLE This is a preliminary report on 125 prospectively enrolled patients who underwent elective decompressive lumbar laminectomy of one to four levels, with or without lumbar fusion. In total, 195 patients will be enrolled; we currently are presenting data from the 125 patients who have completed the protocol to date. OUTCOME MEASURES Primary outcomes included intraoperative estimated blood loss, perioperative change in hemoglobin / hematocrit, transfusion rates, and postoperative drain output. Secondary outcomes included operative and anesthesia time, hospital length of stay (LOS), postoperative complications including venous thromboembolism and infection, and postoperative visual analog scale (VAS) pain scores with morphine milligram equivalents (MME) per day. METHODS A total of 125 patients were randomized preoperatively into one of three treatment arms: control (n=34), topical TXA (n=35), or IV TXA (n=56). The control group received normal saline and did not receive either topical or IV TXA. The topical TXA group received 3g TXA diluted in 250ml of normal saline, which bathed the surgical site undisturbed for 2 minutes prior to wound closure. The IV TXA group received a 10 mg/kg bolus prior to incision followed by a second 10mg/kg dose three hours after the initial dose. The primary and secondary outcome measures were compared between the three groups. Descriptive, ANOVA, chi-squared, and multiple logarithmic regression analysis were utilized. RESULTS No differences were found between the control, IV TXA, and topical TXA groups in intraoperative estimated blood loss (211.2 ± 152.5ml vs 157.1 ± 119.2ml vs 175.6 ± 153ml, p=0.207), postoperative change in hematocrit (7.7 ± 2.9 vs 6.2 ± 3.2 vs 7.0 ± 2.9, p=0.176), and blood transfusion rates (2.9% vs 3.6% vs 0%, p=.5496). Patients who received IV TXA and topical TXA both had significantly less drain output on postoperative day 1 (POD1) than the control group (172 ± 98.2ml vs 72.8 ± 52.9ml vs 52.0 ± 50.0ml, p=0.0001); however, there was no difference in POD1 drain output between the IV and topical groups (p=0.089). There was a decreased risk of requiring pain medication in oral morphine equivalents in the IV and topical TXA groups compared to controls. There were no significant differences in LOS, operative and anesthesia time, pain scores, and postoperative complications. CONCLUSIONS There were significant decreases in POD1 drain output and pain medication requirements in IV and topical TXA patients, when compared to controls, in adult elective lumbar spine patients. There were no observed differences between intraoperative blood loss, postoperative change in hematocrit, or transfusion rates. There were no major TXA-related complications. FDA DEVICE/DRUG STATUS Tranexamic acid (Approved for this indication).