MP68-10 PERIOPERATIVE ASPIRIN USE DURING PERCUTANEOUS NEPHROLITHOTOMY (PCNL): OUR SINGLE CENTER EXPERIENCE.

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy VI1 Apr 2017MP68-10 PERIOPERATIVE ASPIRIN USE DURING PERCUTANEOUS NEPHROLITHOTOMY (PCNL): OUR SINGLE CENTER EXPERIENCE. Joshua Ebel and Bodo Knudsen Joshua EbelJoshua Ebel More articles by this author and Bodo KnudsenBodo Knudsen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2326AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The rates of heart disease and nephrolithiasis continue to increase in the United States. As more patients on aspirin for secondary prevention present with large kidney stones, urologists are increasingly faced with the decision to proceed with the less effective but lower risk ureteroscopy or the higher risk but more effective percutaneous nephrolithotomy (PCNL). Leavitt, Smith, and Okeke recently published their experience performing PCNLs on seventeen patients continued on aspirin perioperatively and concluded that the procedure was safe. We wish to add our center's experience to this body of knowledge. METHODS We retrospectively reviewed our single center, single surgeon, experience of 199 PCNLs performed between January 2013 and September 2016. Hemoglobin pre- and post-operatively was recorded as were the relevant related variables of age, sex, BMI, operative duration, skin-to-stone distance, stone size, aspirin dose, aspirin indication, number of blood transfusions, and Clavien-Dindo complication classification. Correlations between hemoglobin and explanatory variables were then explored with linear regression and the Wilcoxon rank-sum test. RESULTS Of the 199 PCNLs performed at our institution in the range of our study, 27 procedures on 23 patients were conducted without discontinuing aspirin perioperatively. Coronary artery disease was the most common indication for aspirin use. In 24 cases, the patient was on 81 mg of aspirin perioperatively with the remaining three patients on 325 mg of aspirin daily. The average patient experienced a 1.3 g/dl drop in hemoglobin perioperatively. The largest drop was 4.1 g/dl, but the lowest post-operative hemoglobin was 8.2 g/dl. No significant associations were found between hemoglobin decline and age, sex, BMI, operative duration, skin-to-stone distance, or stone size. There were no Clavien-Dindo grade III or higher complications in the course of our review, and no patients required a blood transfusion or embolization. In one case, a patient required a three day inpatient stay following stent removal for continuous bladder irrigation after developing gross hematuria but this resolved spontaneously. CONCLUSIONS In our single center experience, PCNLs performed on patients taking aspirin perioperatively were not associated with the need for blood transfusion nor the occurrence of high-grade complications. It is our experience that this practice is safe when performed by expert hands. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e921-e922 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Joshua Ebel More articles by this author Bodo Knudsen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...