The Impact of Perioperative Aspirin on Bleeding Complications Following Robotic Partial Nephrectomy

Abstract

Perioperative administration of aspirin for high-risk urologic procedures is controversial. We evaluated whether continuation of perioperative aspirin alters bleeding complications in patients who undergo robotic partial nephrectomy (RPN). Retrospective review identified 214 consecutive patients who underwent RPN at our institution from May 2012 to March 2015. Comparisons were performed between 49 patients continuing aspirin (81 mg), 34 patients holding aspirin for at least 7 days before surgery, and 131 patients who had never taken aspirin. Overall bleeding complications included postoperative hemoglobin drop of >3 g/dL during admission, postoperative blood transfusion, or necessity for urgent selective angiographic embolization. Multivariable logistic regression was performed to assess the independent association between aspirin administration and bleeding complications. Patients continuing aspirin were older and had higher Charlson Comorbidity Index (CCI) compared with patients who held or never took aspirin (both p < 0.01). Compared with those who held or never took aspirin, patients continuing aspirin had similar rates of overall bleeding complications (27% vs 15% vs 14%, p = 0.13), hemoglobin drop >3 g/dL (24% vs 15% vs 14%, p = 0.24), and postoperative blood transfusion (4% vs 3% vs 2%, p = 0.43). There was a trend for more frequent need for embolization in patients continuing aspirin (6% vs 3% vs 1%, p = 0.07). On multivariate analysis controlling for CCI and RENAL nephrometry score, aspirin administration was not significantly associated with bleeding complications. Continuation of aspirin was associated with higher overall 30-day complications compared with the other groups (24% vs 12% vs 8%, p = 0.03). Continuation of perioperative 81 mg aspirin for patients undergoing RPN was not associated with significantly higher overall bleeding complications. Patients continuing aspirin had increased comorbidities and overall 30-day complications. While our data suggest that continuing perioperative aspirin is safe in select patients, larger studies are needed to confirm these findings.