Background and Goal of Study: The current practice at our institution has been to continue aspirin therapy up to surgery. The impact to interrupt or continue therapy with aspirin in the perioperative period havebeen recently studied with controversial results.The aim of this study was to assess the safety of radical cistectomy in patients who received aspirin up to the day of surgery.
Materials and methods: We reviewed the records of all patients who underwent radical cystectomy (open and laparoscopic) and urinary diversion between January 2011 and June 2015 in our centre. Perioperative data from patients who underwent radical cystectomy were compiled and analyzed according to the use of aspirin. The unadjusted and adjusted relationship between aspirin use and postoperative complications was evaluated using logistic regression analysis and by the propensity score for aspirin use.
Results and discussion: We included 352 patients, 91 (25.9%) received aspirin up to the day of surgery. Aspirin patients had more co-morbidity and worse functional class (ASA physical status III/IV (%):67/12.1 vs. 37.9/4.2; p< 0.001). Intraoperative blood loss, red blood cell transfusion, cardiac complications and mortality were significantly higher in aspirin group.However, after adjustment for most potential confounders factors, postoperative complications and mortality showed no statistically significant differences between the two groups (Table).



  Unadjusted OR (95% CI) Adjusted OR (95% CI) 
Complications (any) 1.2 (0.7-1.9) 1.1 (0.5-2.2) 
RBC transfusion 2.5 (1.5-4.1) 1.2 (0.6-2.4) 
Postoperative blood loss (ml)* 146.1 (35.4-256.8) 85.9 (-68.8-240.7) 
Respiratory complications 2.1 (0.9-4.4) 2.2 (0.7-6.3) 
Cardiac complications 2.9 (1.1-7.3) 1.7 (0.4-6.8) 
Neurologic complications 2.7 (0.9-8.3) 0.8 (0.1-4.1) 
Re-operation 2.3 (1.3-4.1) 1.02 (0.3-3.9) 
Mortality 1.9 (1.2-3.3) 1.1 (0.5-2.3) 
(*mean differences in ml) CI=Confident interval OR=Odds ratio RBC=Red blood cell     

[Postoperative Events related to aspirin use]


Conclusion(s): Aspirin is not an independent factor for higher risk of postoperative complications or mortality in radical cystectomy. These data suggest that continuation of aspirin is relatively safe in this type of surgery.
References: Kozek-Langenecker SA, Afshari A, Albaladejo P, Santullano CA, De Robertis E, Filipescu DC, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2013;30(6):270-382.

Does aspirin therapy affect outcomes of patients underwent radical cystectomy?