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Risk of aspirin continuation in spinal surgery: a systematic review and meta-analysis
Rik Goes1, Ivo S Muskens2, Timothy R Smith3
1Department of Neurosurgery, Haaglanden Medical Center, Lijnbaan 32, 2512VA, The Hague, The Netherlands.
Insights
Continuing aspirin during spinal surgery showed no significant increase in bleeding or complications. Further research is needed due to limited studies, but current evidence suggests aspirin continuation may be safe.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Cardiovascular Pharmacology
Background:
- Aspirin is often stopped before spinal surgery due to bleeding risks.
- The safety of continuing aspirin during neurosurgery, specifically spinal procedures, requires evaluation.
Purpose of the Study:
- To assess the available evidence on aspirin continuation in spinal surgery.
- To compare perioperative blood loss and complication rates between patients who continued or discontinued aspirin.
Main Methods:
- A systematic review and meta-analysis adhering to PRISMA guidelines.
- Inclusion of studies comparing aspirin continuation versus discontinuation in spinal surgery.
- Extraction and analysis of operative outcomes and complications, including blood loss, operative time, surgical site infections, stroke, and myocardial infarction.
Main Results:
- Three case series were included in the meta-analysis.
- No significant differences were observed in mean operating time or perioperative blood loss between aspirin-continuing and discontinuing groups.
- Similar non-significant differences were found for cardiac events, stroke, and surgical site infections.
Conclusions:
- This meta-analysis indicates no significant increase in perioperative complications with aspirin continuation.
- The limited number of studies necessitates well-designed prospective trials to confirm safety and potential benefits.
Background Context:
Aspirin is typically discontinued in spinal surgery because of increased risk of hemorrhagic complications. The risk of perioperative continuation of aspirin in neurosurgery needed to be evaluated.
Purpose:
This study aimed to evaluate all available evidence about continuation of aspirin and to compare peri- and postoperative blood loss and complication rates between patients that continued aspirin and those who discontinued aspirin perioperatively in spinal surgery.
Study Setting:
Systematic review and meta-analysis were carried out.
Method:
A meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing aspirin continuation with discontinuation were included. Studies using a combination of anticlotting agents or non-spinal procedures were excluded. Operative outcomes (blood loss and operative length) and different complications (surgical site infection [SSI]), stroke, myocardial infarction within 30 days postoperatively) were extracted. Overall prevalence and means were calculated for the reported outcomes in fixed-effects models with heterogeneity (I-squared [I2]) and effect modification (P-interaction) assessment.
Results:
Out of 1,339 studies, three case series were included in the meta-analysis. No significant differences in mean operating time were seen between the aspirin-continuing group (mean=201.8 minutes, 95% confidence interval [CI]=193.3; 210.3; I2=95.4%; 170 patients) and the aspirin-discontinuing group (mean=178.4 minutes, 95% CI=119.1; 237.6; I2=93.5%; 200 patients); (P-interaction=0.78). No significant differences in mean perioperative blood loss were seen between the aspirin-continuing group (mean=553.9 milliliters, 95% CI=468.0; 639.9; I2=83.4%; 170 patients) and the aspirin-discontinuing group (mean=538.7 milliliters, 95% CI=427.6; 649.8; I2=985.5%; 200 patients); (P-interaction=0.96). Similar non-significant differences between the two groups were found for cardiac events, stroke, and surgical site infections.
Conclusions:
This meta-analysis showed an absence of significant differences in perioperative complications between aspirin continuation and discontinuation. Because of the paucity of included studies, further well-designed prospective trials are imperative to demonstrate potential benefit and safety.
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