Perioperative outcomes of aspirin use in radical prostatectomy.

Abstract

150 Background: Increasing cardiovascular disease has led to increases in the patient population on anti-platelet therapy who require urologic surgery. We sought to study perioperative outcomes for those undergoing radical prostatectomy (RP) while taking or not taking perioperative aspirin (pASA). Methods: A retrospective review of patients undergoing RP was performed on the Premier Hospital Database from 2003 to 2015, with survey projection weighting resulting in a cohort of 157,674 patients. Two groups were formed – those continued on pASA (group 1, n = 4400) and those with no pASA (group 2, n = 153,274). In-hospital complication rates were studied: major bleeding, overall transfusion, day-of-surgery transfusion, prolonged ( > 4 days) length of stay (LOS), and prolonged ( > 285 minutes) operative time. We also assessed 90-day rates of: cardiovascular catastrophe, readmission, major complication, and DVT/PE. Unadjusted rates were calculated for all RP patients and further subdivided into open and minimally invasive RP. Adjusted odds ratios (OR) were then calculated between groups 1 and 2. Results: Group 1 was older (51.5% vs 41.8% ≥65 years, p = 0.002) and less healthy (13.8% vs 5.3% with a CCI score ≥2, p < 0.0001) vs those in group 2. Group 1 patients were more likely to receive an open RP (42.3% vs 28.1%, p < 0.0001). For in-hospital outcomes for all RPs, no significant differences were noted regardless of surgical approach. For 90-day outcomes, those in group 1 were more likely to suffer a MI (OR 5.88, CI [3.4-10.18], p < 0.001), major complication (OR2.95, CI [1.58-5.5], p < 0.001), or be readmitted (OR 1.63, CI [1.18-2.26], p < 0.05). The disparity in both MI and major complication rates appeared to be largely driven by those undergoing minimally invasive RPs, with an OR of 7.92 and 4.02 noted, respectively. Conclusions: This large, retrospective, database review of both academic and community hospitals provides an important assessment of the impact pASA has on RP outcomes. In-hospital outcomes were equivalent between groups but those on pASA saw increased rates of MI, major complication, and readmission. Despite this, this study lends support to the belief that pASA should likely not be considered an absolute contraindication to RP.