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Perioperative Outcomes of Aspirin Use in Partial Nephrectomy
Matthew D. Ingham, MD, Ross E. Krasnow, MD, Matthew Mossanen, MD, Ye Wang, PhD, Adam B. Althaus, MD, Steven L. Chang, MD, MS.
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

BACKGROUND: As the incidence of cardiovascular disease continues to increase, so too does the patient population on anti-platelet therapy who requires urologic surgical intervention. We sought to address the perioperative outcomes for those undergoing partial nephrectomy (PN) while taking or not taking perioperative aspirin (ASA).
METHODS: A retrospective review of patients undergoing PN (ICD9 55.4) from 2003 to 2015 was performed on the Premier Hospital Database (Premier Inc, Charlotte NC, USA), a nationally representative hospital discharge dataset. We restricted the study to elective procedures with a diagnosis of an indeterminate or malignant renal mass, and excluded patients with a possible cardiovascular or cerebrovascular event on the day of surgery. To reduce unmeasured confounders, we limited the cohort to hospitals that - during the course of study - had at least one patient that received perioperative aspirin yielding a total cohort of 10,807 patients. The cohort was dichotomized into two groups: those receiving perioperative ASA (7.2%, n=774) and those with no perioperative ASA (92.8%, n=10,033). In terms of outcomes, we assessed in-hospital rates of: major bleeding, overall transfusion, day-of-surgery transfusion, prolonged (>4 days) length of stay (LOS), and prolonged (>285 minutes) operative time. We also assessed 90-day rates of: cardiovascular catastrophe (myocardial infarction and/or cerebrovascular accident), readmission, major complication (Clavien-Dindo ≥3), and deep vein thrombosis/pulmonary embolism. The statistical analysis was based on crude and adjusted logistic regression models, which accounted for patient, hospital, and surgical characteristics.
RESULTS: Patients receiving perioperative ASA tended to be older (58% vs 38% ≥65 years, p<0.0001), predominantly male (73.1% vs 58.7%, p=0.001), and less healthy (34.8% vs 18.4% with a Charlson Comorbidity Index score ≥2, p=0.003). Our analysis showed that perioperative ASA was not associated with increased in-hospital morbidity overall and, only for minimally invasive PN, there was a slightly reduced day-of-surgery transfusion rate (OR 0.29, CI [0.05-0.99], p<0.05). With regards to 90-day outcomes, perioperative ASA use was associated with a significantly elevated odds for a cardiovascular catastrophe (OR 7.56, CI [3.38-16.92], p<0.001); in contrast, specifically for minimally invasive PN, there was a lower likelihood for readmission (OR 0.48, CI [0.24-0.94], p<0.05).
CONCLUSIONS: The current study, which represents the largest study on the impact of perioperative ASA on surgical morbidity of PN, suggests that perioperative ASA can be safely continued among patients undergoing PN.


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