Does Continuation of Low-Dose Aspirin During Robot-Assisted Radical Prostatectomy Compromise Surgical Outcomes?

Abstract

To evaluate the perioperative outcomes and 90-day complication rates of continuation of low-dose aspirin through surgery in patients undergoing robot-assisted radical prostatectomy (RARP). A significant proportion of patients undergoing RARP are on antiplatelet medications for primary or secondary prevention of cardiovascular events. However, there is still a relative lack of data with regard to the advantages and complications of continuing these medications through surgery. Our usual protocol of RARP entails continuation of low-dose aspirin (75 mg once a day) for patients who are already on antiplatelet agents. We conducted a retrospective audit of a prospectively maintained database of 116 cases of RARP performed by a single surgical team in 1 year. Patients were divided into low-dose aspirin group (AG) (n = 31) and nonaspirin group (NAG) (n = 85). The primary objective was to compare the 90-day complication rates to assess the safety profile. Secondary objective was to compare perioperative parameters such as estimated blood loss, blood transfusion rates, fall in hemoglobin (Hb) level, drain outputs on day 1, days to drain removal, lymph node yield, and margin positivity. Subgroup comparison was performed between patients on aspirin for primary prevention (n = 15) and NAG. Both groups were well matched for preoperative parameters except for significantly higher comorbidities and American Society of Anesthesiologists (ASA) score class in AG. Console time, blood loss, fall in Hb level, drain output, drain and catheter removal days, day of discharge, and lymph node yield were comparable. Margin positivity was significantly higher in NAG. Ninety-day complication rates were not significantly different between the two groups (p = 0.218) with only one major complication (Clavien-Dindo grade 4 hypotension requiring intensive care unit admission) in AG. Subgroup comparison demonstrated similar outcomes. Low-dose aspirin can be safely continued perioperatively during RARP, without increasing the bleeding-related complications and overall 90-day complication rates.