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Non-instrumented extradural lumbar spine surgery under low-dose acetylsalicylic acid: a comparative risk analysis
Jehuda Soleman1, Peter Baumgarten2, Wolfgang Nicolas Perrig2
1Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland. jehuda.soleman@gmail.com.
Insights
Continuing low-dose aspirin (ASA) therapy during non-instrumented lumbar spine surgery appears safe. This study found no significant increase in bleeding or cardiovascular complications, suggesting ASA continuation is a viable option for patients undergoing this procedure.
Area of Science:
- Neurosurgery
- Cardiology
- Anesthesiology
Background:
- Coronary artery disease (CAD) is a leading cause of mortality, with acetylsalicylic acid (ASA) widely used for prevention.
- An increasing number of patients on ASA therapy are undergoing spinal surgery.
- Limited data exists on the safety of continuing ASA during lumbar spine surgery.
Purpose of the Study:
- To evaluate peri- and postoperative bleeding.
- To assess cardiovascular complication rates.
- To compare outcomes in patients undergoing non-instrumented, extradural, lumbar spine surgery with or without low-dose ASA discontinuation.
Main Methods:
- Retrospective comparison of 40 patients on ASA and 62 controls.
- Analysis of intra- and postoperative blood loss, morbidity, mortality, and transfusion needs.
- Patients diagnosed with lumbar disc herniation or spinal canal stenosis.
Main Results:
- No statistically significant difference in intraoperative (p=0.08) or postoperative blood loss (p=0.76) between groups.
- One postoperative epidural hematoma in the ASA group versus none in the control group (p=0.40).
- No significant differences in transfusion requirements, hematologic findings, morbidity, or mortality.
Conclusions:
- Continuation of ASA treatment in patients undergoing non-instrumented extradural lumbar spinal surgery appears safe.
- Perioperative continuation of ASA may be recommended for these patients.
- Further studies are needed to confirm these findings.
Purpose:
Coronary artery disease (CAD) affects over one-third of adults and is the leading cause of overall mortality and morbidity. Acetylsalicylic acid (ASA) is widely used in the prevention of CAD. As the population continues to mature, the number of patients presenting for spinal surgery that are under ASA treatment is rising. Studies investigating the outcome of lumbar spine surgeries without discontinuation of ASA therapy are lacking. The purpose of this study is to evaluate the peri- and postoperative bleeding and cardiovascular complication rates of patients undergoing non-instrumented, extradural, lumbar spine surgery with or without discontinuation of low-dose ASA.
Methods:
We retrospectively compared the intra- and postoperative blood loss, morbidity, mortality, blood transfusion requirements and hematologic findings in the ASA group (40 patients) and the control group (62 patients). The diagnosis in all patients was either lumbar disc herniation or spinal canal stenosis.
Results:
Intraoperative blood loss was 221 ml in the ASA group and 140.16 ml in the control group, showing no statistical difference (p = 0.08). Postoperative blood loss was 146.58 and 167.97 ml in the ASA and control groups, respectively, also without statistical difference (p = 0.76). In the ASA group one patient developed a postoperative epidural hematoma needing revision surgery, while in the control group no postoperative epidural hematomas were seen (p = 0.40). In addition, blood transfusion requirements, hematologic findings, morbidity and mortality showed no significant difference.
Conclusion:
The continuation of ASA treatment in patients undergoing non-instrumented extradural lumbar spinal surgery seems to be safe and its perioperative continuation might therefore be recommended. Further studies confirming these results are needed.
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