title: Omega-3 and fish oil supplements do not cause increased bleeding during spinal decompression surgery.
abstract: METHODS
  Retrospective case-control study.
  
  
  OBJECTIVE
  The purpose of this study was to assess whether preoperative use of fish oil supplements increases intraoperative blood loss and postoperative bleeding complications during lumbar decompression surgery.
  
  
  BACKGROUND
  Omega-3 fatty acids (n-3FA) are widely used as over-the-counter supplements because of well-established cardioprotective and antiplatelet effects. Concern over bleeding associated with changes in platelet function have led to prohibiting these supplements before surgery although there are no clinical data available in the spinal surgery literature to guide such recommendations.
  
  
  METHODS
  Ninety-five consecutive patients who underwent posterior-only lumbar decompression by a single surgeon were included. Patients who had taken n-3FA within 14 days of surgery were compared with a control group with respect to demographics, preoperative use of other anticoagulants, surgical time, estimated intraoperative blood loss, and postoperative complications including reoperation for epidural hematoma and wound infection. Power analysis suggested 11 patients taking n-3FA were necessary to reach statistical significance based on pilot data.
  
  
  RESULTS
  Sixteen patients took n-3FA supplements, stopping an average of 2.3 days before surgery. These were no significant between-group differences in demographic parameters, use of other anticoagulants, and surgical time. Estimated blood loss was higher in the control group but the difference was not significant (154 vs. 138 mL, P=0.53). There were 2 complications related to bleeding in the control group and none in the n-3FA group.
  
  
  CONCLUSIONS
  We found no increase in intraoperative blood loss or postoperative bleeding complications associated with preoperative use of n-3FA supplements up to an average of 2.3 days before surgery. Although further studies are necessary before this finding can be generalized to other types of spinal surgery, our study corroborates findings from investigations in other surgical specialties that suggest preoperative n-3FA is not associated with increased risk of intraoperative and postoperative bleeding.
authors.affiliation: Department of Orthopaedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, New York, NY, USA. chris.kepler@gmail.com
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Kepler
authors.forename: Russel C
authors.initials: RC
authors.lastname: Huang
authors.forename: Dennis
authors.initials: D
authors.lastname: Meredith
authors.forename: Joon-Hyung
authors.initials: JH
authors.lastname: Kim
authors.forename: Amit K
authors.initials: AK
authors.lastname: Sharma
mesh_terms: D016063:Blood Loss, Surgical; D019299:Decompression, Surgical / Q000009:adverse effects*; D019587:Dietary Supplements / Q000009:adverse effects*; D015525:Fatty Acids, Omega-3 / Q000009:adverse effects*; D005260:Female; D005395:Fish Oils / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis; D013117:Spinal Cord Compression / Q000150:complications* / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D015525:Fatty Acids, Omega-3; D005395:Fish Oils