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Safety and Clinical Results of Continuous Low-Dose Aspirin in Microendoscopic Laminectomy
Kiyoshi Tarukado1, Teruaki Ono2, Toshio Doi3
1Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Fukuoka, Japan.
Introduction:
It remains controversial whether it is better to continue oral low-dose aspirin (LDA) during the perioperative period in spinal surgery. This study aims to evaluate the safety of continued LDA administration in the perioperative periods of microendoscopic laminectomy (MEL) by assessing perioperative complications and clinical outcomes.
Methods:
We ultimately included 88 patients (35 males, 53 females) who underwent one level of MEL for lumbar spinal canal stenosis from April 2016 to March 2022. Patients who did not undergo anticoagulation therapy were classified into Group A (65 patients), those who stopped anticoagulation therapy at the perioperative periods were classified into Group B (9 patients), and those who continued oral administration of LDA throughout the perioperative periods were classified into Group C (14 patients). Surgery time, intraoperative estimate blood loss (EBL), differences between hemoglobin (Hb) and platelet (Plt) before and after surgery, perioperative complications, and cross-sectional area of hematoma and dural sac on MRI taken within 1 week and at 6 months or more after surgery were assessed between three groups. The EuroQol-5 dimensions (EQ-5D), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were also evaluated as the clinical outcomes.
Results:
There was no statistically significant difference between the three groups in operation time, intraoperative EBL, differences between Hb and Plt before and after surgery, and cross-sectional area of hematoma and dural sac on MRI. A case of hematoma removal was confirmed in Group A. There was also no statistically significant difference between the three groups in EQ-5D, ODI, and each domain of JOABPEQ.
Conclusions:
The continuation of LDA throughout the perioperative periods did not affect perioperative complications and clinical outcomes of one-level MEL. In MEL, it might be possible to continue oral administration of LDA throughout the perioperative periods.
Insights
Continuing low-dose aspirin (LDA) during spinal surgery is safe. This study found no increased complications or worsened outcomes for patients undergoing microendoscopic laminectomy (MEL) who continued LDA.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Pharmacology
Background:
- Controversy exists regarding the perioperative management of low-dose aspirin (LDA) in spinal surgery.
- Assessing the safety of continued LDA during microendoscopic laminectomy (MEL) is crucial for patient care.
Purpose of the Study:
- To evaluate the safety and impact of continued LDA administration during the perioperative period of MEL.
- To compare perioperative complications and clinical outcomes in patients undergoing MEL with varying LDA management strategies.
Main Methods:
- Retrospective analysis of 88 patients undergoing one-level MEL for lumbar spinal canal stenosis.
- Patients were divided into three groups: no anticoagulation, stopped LDA perioperatively, and continued LDA perioperatively.
- Outcomes assessed included operative time, estimated blood loss, hemoglobin/platelet changes, perioperative complications, MRI-measured hematoma/dural sac area, and validated clinical outcome scores (EQ-5D, ODI, JOABPEQ).
Main Results:
- No significant differences were observed in operation time, estimated blood loss, hematologic parameters, or MRI-derived measurements between the groups.
- One case of hematoma removal occurred in the group not receiving anticoagulation.
- Clinical outcomes, including EQ-5D, ODI, and JOABPEQ scores, showed no statistically significant differences across the three groups.
Conclusions:
- Continuation of LDA throughout the perioperative period does not adversely affect perioperative complications or clinical outcomes in patients undergoing one-level MEL.
- It may be safe to continue oral LDA administration throughout the perioperative period for MEL procedures.
