Abstract SNACC-45

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Preoperative Aspirin Therapy Does Not Affect Outcomes after Emergency Neurosurgery

Lee A, Gagnidze A, Pan S, Nair B, Rozet I, Newman S, Vavilala M, Ben-Ari A
University of Washington, Seattle, WA, USA

Introduction: It is common practice to discontinue anti-platelet medications prior to elective neurosurgery. This study was performed to evaluate whether aspirin taken without cessation prior to emergency neurosurgery has a negative impact on patient outcome.

Methods: This is a retrospective chart review on emergency neurosurgical procedures (craniotomies and Burr holes) performed for traumatic subdural, extradural and intraparenchymal hemorrhage over a 5 year period (2008-2012) in a level 1 trauma center. Demographic data, past medical history, ASA classification, history of chronic antiplatelet and anticoagulant medications, surgical and anesthesia intraoperative data were gathered. Patients older than 49 years were included into the study. Exclusion criteria were: 1)chronic preoperative treatment with anticoagulants or antiplatelet agents other than aspirin, 2) concomitant traumatic injuries requiring surgery, 3)repeat neurosurgery. In-hospital mortality was considered as a primary outcome measure. Secondary outcome measures were: perioperative volume of blood products transfused from 48 hours before to 48 hours after surgery, length of ICU stay and mechanical ventilation, and length of hospital stay. Patients on aspirin preoperatively were compared to non-aspirin patients using a logistic regression model to control for patient age and GCS on admission, with the dependent variable for each outcome dichotomized to either greater than or equal to the median value or less than the median value. P < 0.05 was considered statistically significant.

Results: There were 311 patients identified in the cohort (68.2 ± 12 years, 63% male): Aspirin patients (n=120, 72.6 ± 12 years, 61% male) were older than non-aspirin patients (n=191, 65.5 ± 12 years, 64% male), p<0.001, and had a higher GCS score at admission (13 ± 4) compared to non-aspirin patients (11 ± 4), p<0.0001. In-hospital mortality in the cohort was 19.6% (13% in Aspirin and 24% in Non-aspirin group). In the whole cohort, the only predictor of mortality was a low GCS score (higher GCS: OR=0.86; 95% CI, 0.79-0.9). Preoperative aspirin was not associated with increased mortality, ICU and hospital length of stay, or number of ventilator days.

Conclusions: Chronic aspirin treatment in patients older than 49 years without cessation does not worsen outcomes after emergency neurosurgery. Additional studies are warranted to consider whether the benefits of continuing aspirin prior to elective neurosurgery outweigh the risks of discontinuing it.

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