title: An acute care surgery dilemma: emergent laparoscopic cholecystectomy in patients on aspirin therapy.
abstract: BACKGROUND
  The current literature regarding hemorrhagic complications in patients on long-term antiplatelet therapy undergoing emergent laparoscopic cholecystectomy is limited. The aim of our study was to describe hemorrhagic complications in patients on prehospital aspirin (ASP) therapy undergoing emergent cholecystectomy.
  
  
  METHODS
  We performed a 1-year retrospective analysis of our prospectively maintained acute care surgery database. The 2 groups (ASP group vs No ASP group) were matched in a 1:1 ratio for age, sex, previous abdominal surgeries, and comorbidities. Primary outcome measures were intraoperative hemorrhage, postoperative anemia, need for blood transfusion, and conversion to open cholecystectomy. Intraoperative hemorrhage was defined as intraoperative blood loss of ≥ 100 mL; postoperative anemia was defined by ≥ 2 g/dL drop in hemoglobin.
  
  
  RESULTS
  A total of 112 (ASP: 56, no ASP: 56) patients were included in the analysis. The mean age was 65.9 ± 10 years, and 50% were male. There was no difference in age (P = .9), sex (P = .9), and comorbidities (P = .7) between the 2 groups. There was no difference in intraoperative blood loss >100 mL (P = .5), postoperative anemia (P = .8), blood transfusion requirement (P = .9), and conversion to open surgery (P = .7) between patients on American Society of Anesthesiologists therapy and patients not on American Society of Anesthesiologists therapy.
  
  
  CONCLUSIONS
  Emergent laparoscopic cholecystectomy is a safe procedure in patients on long-term ASP. Prehospital use of ASP as an independent factor should not be used to delay emergent cholecystectomy.
authors: Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, 1501 N Campbell Avenue, Tucson, AZ 85724, USA. Electronic address: bjoseph@surgery.arizona.edu.
authors: Bellal
authors: B
authors: Joseph
authors: Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, 1501 N Campbell Avenue, Tucson, AZ 85724, USA.
authors: Badi
authors: B
authors: Rawashdeh
authors: Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, 1501 N Campbell Avenue, Tucson, AZ 85724, USA.
authors: Hassan
authors: H
authors: Aziz
authors: Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, 1501 N Campbell Avenue, Tucson, AZ 85724, USA.
authors: Narong
authors: N
authors: Kulvatunyou
authors: Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, 1501 N Campbell Avenue, Tucson, AZ 85724, USA.
authors: Viraj
authors: V
authors: Pandit
authors: Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, 1501 N Campbell Avenue, Tucson, AZ 85724, USA.
authors: Qasim
authors: Q
authors: Jehangir
authors: Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, 1501 N Campbell Avenue, Tucson, AZ 85724, USA.
authors: Terence
authors: T
authors: O'Keeffe
authors: Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, 1501 N Campbell Avenue, Tucson, AZ 85724, USA.
authors: Andrew
authors: A
authors: Tang
authors: Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, 1501 N Campbell Avenue, Tucson, AZ 85724, USA.
authors: Donald J
authors: DJ
authors: Green
authors: Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, 1501 N Campbell Avenue, Tucson, AZ 85724, USA.
authors: Randall S
authors: RS
authors: Friese
authors: Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, 1501 N Campbell Avenue, Tucson, AZ 85724, USA.
authors: Peter
authors: P
authors: Rhee
mesh_terms: D000368:Aged; D001241:Aspirin / Q000009:adverse effects*; D017081:Cholecystectomy, Laparoscopic; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: Acute cholecystitis; Aspirin therapy; Emergent cholecystectomy; Hemorrhagic complications