Outcomes of Laparoscopic Partial Nephrectomy in Patients Continuing Aspirin Therapy
PURPOSE: Clinical dilemma surrounds the use of aspirin therapy during laparoscopic partial nephrectomy. Despite reduced cardiac morbidity with perioperative aspirin use, fear of bleeding-related complications often prompts discontinuation of therapy prior to surgery. We evaluate perioperative outcomes among patients continuing aspirin and those in whom treatment is stopped preoperatively. MATERIALS AND METHODS: 430 consecutive cases of laparoscopic partial nephrectomy performed between January 2012 and October 2014 were reviewed. Patients on chronic aspirin therapy were stratified into two groups, on-aspirin and off-aspirin, based on perioperative status of aspirin use. Primary endpoints evaluated included estimated intraoperative blood loss and incidence of bleeding-related complications, major postoperative complications, and thromboembolic events. Secondary outcomes included operative time, transfusion rate, length of hospital stay, readmission rate, and surgical margin status. RESULTS: Among 101 (23.4%) patients on chronic aspirin therapy, antiplatelet treatment was continued in 17 patients (16.8%). One patient in the on-aspirin group developed bleeding postoperatively period requiring angioembolization. Conversely, one myocardial infarction was observed in the off-aspirin cohort. There was no significant difference in incidence of major postoperative complications, intraoperative blood loss, transfusion rate, length of hospital stay, and readmission rate. Operative time was increased with continued aspirin use (181 min vs. 136 min, p=0.01). CONCLUSIONS: Laparoscopic partial nephrectomy is safe and effective among patients on chronic antiplatelet therapy who require perioperative aspirin for cardio-protection. Larger, prospective studies are necessary to discern the true cardiovascular benefit derived from continued aspirin therapy as well better characterize associated bleeding risk.
Faculty, Northwell Researcher
School of Medicine; Northwell Health