PD48-10 EXAMINATION OF PERIOPERATIVE OUTCOMES FOLLOWING PARTIAL NEPHRECTOMY PERFORMED ON PATIENTS REMAINING ON ANTIPLATELET THERAPY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy VI1 Apr 2016PD48-10 EXAMINATION OF PERIOPERATIVE OUTCOMES FOLLOWING PARTIAL NEPHRECTOMY PERFORMED ON PATIENTS REMAINING ON ANTIPLATELET THERAPY Timothy Ito, Philip Abbosh, Serge Ginzburg, Ithaar Derweesh, Omer Raheem, Hossein Mirheydar, Zachary Hamilton, David Chen, Marc Smaldone, Alexander Kutikov, Richard Greenberg, Rosalia Viterbo, and Robert Uzzo Timothy ItoTimothy Ito More articles by this author , Philip AbboshPhilip Abbosh More articles by this author , Serge GinzburgSerge Ginzburg More articles by this author , Ithaar DerweeshIthaar Derweesh More articles by this author , Omer RaheemOmer Raheem More articles by this author , Hossein MirheydarHossein Mirheydar More articles by this author , Zachary HamiltonZachary Hamilton More articles by this author , David ChenDavid Chen More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , and Robert UzzoRobert Uzzo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2732AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The increased prevalence of drug-eluting coronary stents has led to a rise in the number of surgeries performed on patients who must remain on anti-platelet (AP) therapy. The risks of performing a partial nephrectomy on patients on AP therapy are underreported. In this multi-institutional study we evaluated the perioperative outcomes of these patients. METHODS Data from 1097 patients undergoing partial nephrectomy at two institutions between 2002-2014 was reviewed from prospectively collected databases. Patients were separated into three groups: AP therapy during surgery (Group I, n=67), chronic AP therapy preoperatively who stopped >5 days prior to surgery (Group II, n=254), and not on chronic AP therapy (Group III, n=776). Bleeding complications within 30 days of surgery were defined as transfusion of >2U PRBC or any readmission or secondary procedure performed primarily due to hemorrhage. Chi-square and one-way ANOVA were used for univariate analysis. Multivariable analysis (MVA) was performed using logistic regression. RESULTS The primary indication for the continuation AP therapy intraoperatively was due to cardiovascular comorbidities in 91%. Patients in group I were older (mean 66 vs. 64 and 56 years old in groups II and III respectively, p<0.0001), more frequently male (81% vs. 67% and 61%, p=0.002), less frequently Caucasian (34% vs. 20% and 20%, p=0.004) and had more comorbid conditions (mean ASA score 2.88 vs 2.42 and 2.19, p<0.0001). Group I patients experienced a significantly higher rate of bleeding complications (11.9% vs 2.4% and 2.4%, p<0.0001) and a higher transfusion rate (16.4% vs 5.9% and 4.5%, p=0.0002). On MVA controlling for clinical factors, use of any intraoperative AP therapy was predictive of an increased risk for bleeding complications (OR 4.04, p=0.005). These findings appear to be attributable to intraoperative clopidogrel use, as patients on only aspirin during partial nephrectomy did not demonstrate bleeding complication rates that were significantly higher than patients in groups II and III in univariate or multivariate analysis. CONCLUSIONS Use of clopidogrel at the time of partial nephrectomy was associated with an increased risk for bleeding complications. Perioperative aspirin use does not appear to be associated with higher rates of adverse bleeding events postoperatively. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1179 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Timothy Ito More articles by this author Philip Abbosh More articles by this author Serge Ginzburg More articles by this author Ithaar Derweesh More articles by this author Omer Raheem More articles by this author Hossein Mirheydar More articles by this author Zachary Hamilton More articles by this author David Chen More articles by this author Marc Smaldone More articles by this author Alexander Kutikov More articles by this author Richard Greenberg More articles by this author Rosalia Viterbo More articles by this author Robert Uzzo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...