Perioperative Aspirin Use Is Associated with Bleeding Complications during Robotic Partial Nephrectomy

Abstract

Purpose: Daily aspirin use following cardiovascular intervention is commonplace and creates concern regarding bleeding risk in patients undergoing surgery. Despite its cardio-protective role, aspirin is often discontinued 5e7 days prior to major surgery due to bleeding concerns. Single institution studies have investigated perioperative outcomes of aspirin use in robotic partial nephrectomy (RPN). We sought to evaluate the outcomes of perioperative aspirin (pASA) use during RPN in a multicenter setting. Materials and Methods: We performed a retrospective evaluation of patients undergoing RPN at 5 high volume RPN institutions. We compared perioperative outcomes of patients taking pASA (81 mg) to those not on aspirin. We analyzed the association between pASA use and perioperative transfusion. Results: Of 1,565 patients undergoing RPN, 228 (14.5%) patients continued pASA and were older (62.8 vs 56.8 years, p <0.001) with higher Charlson scores (mean 3 vs 2, p <0.001). pASA was associated with increased perioperative blood transfusions (11% vs 4%, p <0.001) and major complications (10% vs 3%, p <0.001). On multivariable analysis, pASA was associated with increased transfusion risk (OR 1.94, 1.10e3.45, 95% CI). Conclusions: In experienced hands, perioperative aspirin 81 mg use during RPN is reasonable and safe; however, there is a higher risk of blood transfusions and major complications. Future studies are needed to clarify the role of antiplatelet therapy in RPN patients requiring pASA for primary or secondary prevention of cardiovascular events.

Cost Implications of Routine Preoperative Blood Typing and Crossmatching Prior to Robot-Assisted Laparoscopic Partial Nephrectomy

“…The early reported outcomes of RAPN reported a transfusion rate ranging from 3% to 10%, but as techniques and physician experience have matured, the transfusion risk has continued to decline. 6,7 Despite this trend, preoperative blood typing and crossmatching is routine for patients undergoing RAPN and mirrors the practices of the open surgical era. We aim to define the transfusion rate of patients undergoing RAPN at an academic medical center to further understand the potential cost savings if routine blood typing is modified or eliminated in a high-volume RAPN practice.…”