SUO 2017: Perioperative Outcomes of Aspirin Use in Partial Nephrectomy

Washington, DC ( Increasing cardiovascular disease has led to increased use of anti-platelet therapy in a patient population who often require urologic surgery. Dr. Ingham and colleagues presented their research assessing perioperative outcomes of aspirin use in partial nephrectomy patients. The objective of the study was to assess perioperative outcomes for those undergoing partial nephrectomy while taking or not taking perioperative aspirin.

The author’s utilized the Premier Hospital database to identify 10,807 patients undergoing partial nephrectomy from 2003 to 2015. Two groups were identified: those continued on perioperative aspirin (n=774) and those with no perioperative aspirin (n=10,033). Both in-hospital and 90-day complication rates were examined. Specifically, the authors assessed in-hospital rates of: major bleeding, overall transfusion, day-of-surgery transfusion, prolonged (>4 days) length of stay, and prolonged (>285 minutes) operative time. Also assessed was 90-day rates of: cardiovascular catastrophe, readmission, major complication, and deep vein thrombosis/pulmonary embolism.

Unadjusted rates were calculated for all partial nephrectomy patients and further subdivided into open partial nephrectomy and minimally invasive partial nephrectomy. Odds ratios (OR) were then calculated between the two groups after adjusting for all baseline characteristics. Patients continuing perioperative aspirin 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 CCI score ≥2, p=0.003) as compared to those not taking perioperative aspirin. For in-hospital outcomes, no significant differences were noted between the groups. Stratifying by surgical approach, those continuing perioperative aspirin undergoing minimally invasive partial nephrectomy were slightly less likely to require a day-of-surgery transfusion (OR 0.29, 95%CI 0.05-0.99, p<0.05). For 90-day outcomes, those continuing perioperative aspirin were far more likely to suffer a cardiovascular catastrophe (OR 7.56, 95%CI 3.38-16.92, p<0.001) regardless of surgical approach. Conversely, these patients were slightly less likely to experience readmission (OR 0.48, 95%CI 0.24-0.94, p<0.05) and were likely driven by those undergoing minimally invasive partial nephrectomy.

In conclusion, this study of academic and community hospitals provides insight into the impact of perioperative aspirin on partial nephrectomy outcomes. In-hospital outcomes were largely equivalent between groups while 90-day cardiovascular catastrophe rates were much higher in the aspirin group. Despite this, this study lends support to the belief that perioperative aspirin should not be considered an absolute contraindication to partial nephrectomy.

Presented by: Matthew D. Ingham, MD

Co-Authors: Ross Krasnow MD, Matthew Mossanen MD, Ye Wang PhD and Steven Chang MD, MS

Affiliation:  Division of Urology, Brigham and Women's Hospital, Boston, MA

Written by: Zachary Klaassen, MD, Society of Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre @zklaassen_md at the 18th Annual Meeting of the Society of Urologic Oncology, November 20-December 1, 2017 – Washington, DC