New hospital policy slashes blood transfusions in major surgeries

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Cluster-level inclusion criteria: Hospital sites will be included in the trial if the site performs ≥ 100 noncardiac surgeries per month, and if anesthesia, surgery and hospital leadership agree to manage patients as per the policy being implemented and evaluated in the trial. Patient-level inclusion criteria: * Patients \>/= 18 years of age undergoing major non-cardiac surgery (a state of hyperfibrinolysis) * Inpatient surgeries with an estimated \>/= 5% risk of RBC transfusion, including open surgeries or laparoscopic surgeries with an estimated duration of \>/= 3 hours Examples of eligible surgeries could include (but are not limited to): 1. General surgery (esophagectomy, gastrectomy, gastric repair, small bowel repair or resection, ostomy formation, colon/rectum repair or resection, colostomy, splenectomy, hepatectomy, pancreatectomy, resection of abdominal mass) 2. Orthopedics (hip fracture repair, pelvic fixation, femur repair / fixation, shoulder / humerus open reduction internal fixation, lower extremity amputation) 3. Spine (vertebrectomy, surgery involving \>/= 3 levels) 4. Otolaryngology (glossectomy, mandibulectomy, radical laryngectomy) 5. Thoracic (lung resection or decortication) 6. Vascular (arterial bypass / endarterectomy / aneurysmorrhaphy involving the aorta or proximal vessels off the aorta) 7. Gynecology (hysterectomy) 8. Urology (nephrectomy, cystectomy, prostatectomy, pelvic exenteration) 9. Plastic surgery (large neoplasm resections, burns or debridements) 10. Surgeries anticipated to be associated with 5% or greater risk of RBC transfusion in hospital as per the surgical team. Exclusion Criteria: * Active thromboembolic disease (i.e., arterial or venous thrombosis within 90 days preoperative) * Pregnancy * Cardiac surgery and hip and knee arthroplasty where TXA is standard-of-care * Surgeries with free flap reconstruction * Trauma surgeries where TXA was administered within the previous 3 hours.