Perioperative Tranexamic Acid Reduces Bleeding and Wound Complications in Post-Bariatric Abdominoplasty: A Retrospective Cohort Study

<b>Background:</b> Post-bariatric abdominoplasty is associated with a high risk of bleeding and wound complications due to extensive tissue resection and impaired tissue quality. Tranexamic acid (TXA) reduces perioperative bleeding in multiple surgical disciplines, but evidence in massive-weight-loss abdominoplasty is limited. The aim of our study was to evaluate the association between perioperative TXA use and bleeding-related and surgical outcomes in post-bariatric abdominoplasty. <b>Methods:</b> This retrospective cohort study included 97 patients undergoing post-bariatric abdominoplasty, of whom 49 received perioperative TXA and 48 did not. The primary outcome was a composite of bleeding-related complications within 30 days, including hematoma, clinically relevant bleeding, or reoperation. Secondary outcomes included overall and specific surgical site complications, drain output and duration, length of hospital stay, and perioperative hemoglobin changes. Multivariable regression analyses adjusted for body mass index, abdominoplasty type, and year of surgery. <b>Results:</b> Bleeding-related complications were significantly lower in the TXA group compared with controls (4.1% vs. 33.3%; unadjusted OR 0.09, 95% CI 0.02-0.40; <i>p</i> < 0.001). This association remained significant after adjustment (adjusted OR 0.13, 95% CI 0.03-0.68; <i>p</i> = 0.016). TXA use was associated with lower cumulative drain output (median 200 vs. 382.5 mL; <i>p</i> < 0.001) and shorter drainage duration (median 4 vs. 5 days; <i>p</i> < 0.001). Overall complications were reduced in the TXA group (42.9% vs. 66.7%; <i>p</i> = 0.025), driven by fewer wound healing disturbances. Hemoglobin changes, seroma, and infection rates were similar between groups. <b>Conclusions:</b> Perioperative TXA use in post-bariatric abdominoplasty is associated with significantly fewer bleeding-related and wound complications without increased adverse effects, supporting its use in this high-risk population.