A survey evaluating surgeons' peri-operative usage of acetyl-salicylic acid (ASA) and their willingness to enroll their patients in a perioperative ASA randomized controlled trial.
OBJECTIVE
Major cardiovascular complications associated with noncardiac surgery represent a substantial population health problem for which there are no established efficacious and safe prophylactic interventions. Acetyl-salicylic acid (ASA) represents a promising intervention. The objective of this study was to determine surgeons' perioperative usage of ASA, and if they would enroll their patients in a perioperative ASA randomized controlled trial (RCT).


METHODS
Cross-sectional survey of all practicing Canadian general, orthopedic, and vascular surgeons. Our mailed, self-administered survey asked surgeons to consider only their patients who were at risk of a major perioperative cardiovascular complication.


RESULTS
The response rate was 906/1854 (49%). For patients taking ASA chronically, there was marked variability regarding ASA continuation prior to surgery amongst the general and orthopedic surgeons, whereas 76% of vascular surgeons continued ASA in 81-100% of their patients. For patients not taking ASA chronically, approaches to starting ASA prior to surgery were variable amongst the vascular surgeons, whereas 70% of general and 82% of orthopaedic surgeons did not start ASA. For patients taking ASA chronically, 73% of general surgeons, 70% of orthopaedic surgeons, and 36% of vascular surgeons would allow at least 40% of their patients to participate in a perioperative RCT comparing stopping versus continuing ASA. For patients not taking ASA chronically, most general (76%), orthopaedic (67%), and vascular (51%) surgeons would allow at least 40% of their patients to participate in a perioperative RCT comparing starting ASA versus placebo.


CONCLUSIONS
This national survey demonstrates that perioperative ASA usage as reported by surgeons is variable, identifying the need for, and community interest in, a large perioperative ASA trial.
McMaster University Health Sciences Centre, 1200 Main Street West, Hamilton, Ontario, Canada. philipj@mcmaster.ca
Rajesh
R
Hiralal
Gordon
G
Guyatt
Mohit
M
Bhandari
Deborah
D
Cook
Otavio
O
Berwanger
Justin
J
De Beer
Claudio
C
Cina
Norm
N
Buckley
Juan Carlos
JC
Villar
Victor
V
Montori
Michael
M
Marcaccio
James
J
Paul
Laura
L
Whiteacre
P J
PJ
Devereaux
D001241:Aspirin / Q000627:therapeutic use*; D002170:Canada; D003430:Cross-Sectional Studies; D006801:Humans; D010820:Physicians / Q000523:psychology* / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic
D001241:Aspirin