Is preoperative withdrawal of aspirin necessary in patients undergoing elective inguinal hernia repair?

Ong, Wilson; Shen, Tong; Tan, Wee Boon; Lomanto, Davide

doi:10.1007/s00464-016-4926-6

Cited by 17 publications

(17 citation statements)

References 41 publications

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“…The outcomes were satisfactory even for bilateral hernia repairs. Our results are in accordance with earlier studies conducted in inguinal hernia patients undergoing open Lichtenstein repair in a similar setting [25, 26]. However, no study was known to compare the outcomes of IHR using the UHS technique under LA.…”

Section: Discussionsupporting

confidence: 92%

Safety of Inguinal Hernia Repair in the Elderly with Perioperative Continuation of Antithrombotic Therapy

et al. 2020

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Introduction: This study aimed to evaluate the safety of an inguinal hernia repair (IHR) under local anesthesia (LA) in the elderly with a perioperative continuation of antithrombotic therapy (AT). Methods: A total of 120 patients undergoing elective primary IHR between August 2018 and August 2019 at the West China Hospital of China were prospectively studied, among which 60 patients also had coexisting cardiovascular diseases and had a continuation of AT perioperatively (antithrombotic group); the other 60 patients were not on any prior AT (control group). The primary endpoints were intra- and postoperative hemorrhagic complications, the required interventions for complications based on the Clavien-Dindo classification, and postoperative thromboembolic complications. The secondary endpoints were nonhemorrhagic complications, intraoperative duration, and postoperative length of stay (LOS). Results: None of the patients in both groups had significant intraoperative bleeding >10 mL, and there were no significant differences between the 2 groups in terms of the postoperative hemorrhagic complications: bruising (2 vs. 0%, p = 1.000), serosanguinous soakage (7 vs. 3%, p = 0.679), and no hematoma was observed. Interventions required for encountered complications based on the Clavien-Dindo classification grade I (7 vs. 5%, p = 1.000) were assessed. There were no episodes of postoperative thromboembolic complications within 60 days in both groups. There were also no significant differences between the 2 groups in terms of nonhemorrhagic complications, intraoperative duration, and postoperative LOS (p > 0.05 in all). Conclusions: The perioperative continuation of AT did not increase the risk of intra- and postoperative hemorrhagic complications following IHR in the elderly. Thus, IHR under LA seems to be safe and feasible in this setting.

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Section: Discussionsupporting

confidence: 92%

Safety of Inguinal Hernia Repair in the Elderly with Perioperative Continuation of Antithrombotic Therapy

et al. 2020

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“…Overall, 39 reports were found to be relevant to the research question. Of these, 3 were randomized controlled trials [11], [12], [13], 5 were prospective studies [14], [15], [16], [17], [18], 4 were case reports [10], [19], [20], [21], 25 were retrospective (registry) studies [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], and 2 were meta-analyses [47], [48].…”

Section: Methodsmentioning

confidence: 99%

Risk factors for perioperative complications in inguinal hernia repair – a systematic review

Weyhe

Tabriz

Sahlmann

et al. 2017

Innovative Surgical Sciences

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Abstract:The current literature suggests that perioperative complications occur in 8%-10% of all inguinal hernia repairs. However, the clinical relevance of these complications is currently unknown. In our review, based on 571,445 hernia repairs reported in 39 publications, we identified the following potential risk factors: patient age, ASA score, diabetes, smoking, mode of admission (emergency vs. elective surgery), surgery in low resource settings, type of anesthesia, and (in men) bilateral and sliding hernias. The most commonly reported complications are bleeding (0.9%), wound infection (0.5%), and pulmonary and cardiovascular complications (0.2%). In 3.9% of the included publications, a reliable grading of the reported complications according to Clavien-Dindo classification was possible. Using this classification retrospectively, we could show that, in patients with complications, these are clinically relevant for about 22% of these patients (Clavien-Dindo grade ≥ IIIa). About 78% of all patients suffered from complications needing only minor (meaning mostly medical) intervention (Clavien-Dindo grade < III). Especially with regard to the low incidence of complications in inguinal hernia repair, future studies should use the Clavien-Dindo classification to achieve better comparability between studies, thus enabling better correlation with potential risk factors.

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“…17 There was a higher frequency of preoperative use of aspirin and oral anticoagulants in SLE patients, without impact on the amount of bleeding or blood transfusion requirements, similar to previous findings in non-SLE patients undergoing surgery. 18 However, aspirin use was independently associated with the presence of any postoperative complication in our SLE patients. Other studies have shown greater risk of bleeding and renal failure, with no differences in cardiovascular events in patients receiving preoperative low-dose aspirin compared to placebo in noncardiac surgery.…”

Section: Discussionmentioning

confidence: 64%

Risk factors for development of early infectious and noninfectious complications in systemic lupus erythematosus patients undergoing major surgery

Quintanilla-González

Torres‐Villalobos

Hinojosa‐Azaola

2018

Lupus

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Background We aimed to identify risk factors for early complications in systemic lupus erythematosus (SLE) patients undergoing major surgery. Methods We conducted a retrospective comparative cohort study including patients with SLE undergoing major surgery, and non-SLE patients matched 1:1. Main outcomes were development of infectious and noninfectious complications, and 30-day postoperative mortality. Results A total of 382 patients (191 SLE and 191 non-SLE) were included. Postoperative complications occurred in 82 (43%) SLE patients and 58 (30%) without SLE, ( p = 0.01). Variables associated with infectious complications in SLE patients: prednisone use (OR 1.81, 95% CI 1.13-2.90), anemia (OR 2.43, 95% CI 1.45-4.08), hypoalbuminemia (OR 2.58, 95% CI 1.55-4.30) and lymphopenia (OR 2.43, 95% CI 1.52-3.89), p < 0.05. Variables associated with noninfectious complications: anemia (OR, 1.93, 95% CI 1.03-3.64) and hypoalbuminemia (OR 2.11, 95% CI 1.16-3.86), p < 0.05. Variables associated with any complication: SLEDAI-2K (OR 1.1, 95% CI 1.01-1.20), nephritis (OR 10.08, 95% CI 1.21-83.63), aspirin use (OR 2.68, 95% CI 1.19-6.02, p = 0.01), low C3 (OR 2.00, 95% CI 1.06-3.80), anemia (OR 2.68, 95% CI 1.39-5.18), hypoalbuminemia (OR 3.49, 95% CI 1.83-6.66) and lymphopenia (OR 2.36, 95% CI 1.30-4.26), p < 0.05. More patients with SLE died (6% vs 1%, p = 0.02). Conclusions SLE patients present higher frequency of postoperative complications and mortality compared with non-SLE patients. Hypoalbuminemia, anemia, lymphopenia and aspirin use are independent risk factors.

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Is preoperative withdrawal of aspirin necessary in patients undergoing elective inguinal hernia repair?

Abstract: Continuation of aspirin is safe and should be preferred in patients with higher cardiovascular risk.

Cited by 17 publications

References 41 publications

Safety of Inguinal Hernia Repair in the Elderly with Perioperative Continuation of Antithrombotic Therapy

Safety of Inguinal Hernia Repair in the Elderly with Perioperative Continuation of Antithrombotic Therapy

Risk factors for perioperative complications in inguinal hernia repair – a systematic review

Risk factors for development of early infectious and noninfectious complications in systemic lupus erythematosus patients undergoing major surgery

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