EAU 2018: Perioperative Outcomes of Aspirin Use in Partial Nephrectomy

Copenhagen, Denmark (UroToday.com) Rising incidence of cardiovascular disease has led to increases in the patient population using anti-platelet therapy who require urologic surgery. The authors sought to study perioperative outcomes for those undergoing partial nephrectomy (PN) while taking or not taking perioperative aspirin (pASA).

A retrospective review of patients undergoing PN was performed on the Premier Hospital Database from 2003 to 2015, with survey projection weighting resulting in a cohort of 10,807 patients. Two groups were formed – those continued on pASA (group 1, n=774) and those with no pASA (group 2, n=10,033). Both in-hospital and 90-day complication rates were examined. Specifically, 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 were assessed. Furthermore, 90-day rates of: cardiovascular catastrophe, readmission, major complication, and deep vein thrombosis/pulmonary embolism were analyzed. Unadjusted rates were calculated for all PN patients and further subdivided into open PN and minimally invasive PN. Odds ratios (OR) were then calculated between groups 1 and 2 after adjusting for all baseline characteristics.

Patients in group 1 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 of ≥2, p=0.003) as compared to those in group 2. For in-hospital outcomes, no significant differences were noted between the groups. Stratifying by surgical approach, those in group 1 undergoing minimally invasive PN were slightly less likely to require a day-of-surgery transfusion (OR 0.29, CI [0.05-0.99], p<0.05). For 90-day outcomes, group 1 were far more likely to suffer a cardiovascular catastrophe (OR 7.56, CI [3.38-16.92], p<0.001) regardless of surgical approach. Conversely, group 1 was slightly less likely to experience readmission (OR 0.48, CI [0.24-0.94], p<0.05) and was likely driven by those undergoing minimally invasive PN.

This large review of academic and community hospitals provides insight into the impact perioperative ASA has on PN outcomes. As noted, in-hospital outcomes were largely equivalent between groups while 90-day cardiovascular catastrophe rates were much higher in the ASA group. Despite this, this study supports the belief that pASA should not be considered an absolute contraindication to PN.

Presented by: Ingham M, Brigham and Women's Hospital, Harvard Medical School, Dept. of Urologic Surgery, Boston, USA

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, twitter: @GoldbergHanan at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark