Perioperative Safety of Lumbar Decompression Surgery Performed Under Continuous Low-Dose Aspirin Administration

Retrospective clinical analysis.

To investigate the changes in perioperative bleeding and overall safety associated with the use of low-dose aspirin (LDA) in spinal surgery.

There is no consensus on whether to continue the use of LDA in patients requiring spinal surgery. Furthermore, previous studies have shown inconsistent results regarding the impact of LDA on the risk of intraoperative and postoperative bleeding.

A retrospective cohort study was conducted at a single institution from 2014 to 2023, involving 375 patients diagnosed with lumbar spinal stenosis. Of these, 98 were on LDA therapy and 207 were not. After excluding those on other antiplatelet or anticoagulant therapies, propensity score matching was applied, resulting in 2 groups of 89 patients each. The study assessed variables such as operative time, intraoperative blood loss, postoperative drain volume, and hemoglobin level changes up to 1-week postsurgery.

The LDA-treated group (L group) experienced significantly higher intraoperative blood loss (70.3 mL) compared with the non-LDA-treated group (N group; 46.4 mL, P = 0.003). Postoperative drain volumes did not differ significantly, but postoperatively, hemoglobin levels decreased by 2.2 g/dL in the L group and by 1.9 g/dL in the N group after 1 week ( P = 0.04). There were no significant differences in the rate of postoperative transfusions or serious bleeding complications between the groups.

Although LDA use was associated with increased intraoperative blood loss and a significant drop in postoperative hemoglobin levels, it did not lead to serious bleeding complications. These findings suggest that with careful management, LDA can be safely continued in patients undergoing lumbar decompression surgery. However, the generalizability of these results is limited by the observational nature of the study and its single-center design.

Level III.