Is the Perioperative Continuation of Antiplatelet Therapy Safe for Elective Hernia Surgery?

Abstract

Antiplatelet medication use in the perioperative period for elective surgical procedures remains controversial. We hypothesized that for elective hernioplasty, the continuation of antiplatelet agents would not increase postoperative complications. A single surgeon prospectively tracked all elective hernia repairs performed. All patients were included except those on anticoagulation therapy. Patients already on antiplatelet therapy (APT) continued their regimen throughout the perioperative period, whereas those who were not remained off antiplatelet medications. All patients had postoperative visits between 7 and 10 days at which point they were evaluated with complications documented. One thousand four patients underwent open hernia repair. Two hundred sixty-seven patients were taking APT, whereas 737 were not. The mean age of the antiplatelet group was greater than those not on APT (66 vs 51 years old, P < 0.0001). Ecchymosis occurred more frequently in the APT group than in those not on APT (9.36% vs 2.71%, P = 0.0005). This was the only statistically significant difference in postoperative complications noted between these two groups. Patients taking clopidogrel alone or a combination of aspirin and clopidogrel had a significantly higher rate of ecchymosis compared with those on other antiplatelet regiments (10%, 21.6%, and 7.4%, respectively, P = 0.047). There were no postoperative hematomas, bleeding complications, urinary retention, or any patients who required cessation of antiplatelet medications. Continuation of APT in the perioperative period for elective hernia repair did not result in an increased frequency of postoperative complications except for ecchymosis development. We conclude that the continuation of antiplatelet medications throughout the perioperative period of elective hernioplasty is safe.