title: Outcomes of Laparoscopic Partial Nephrectomy in Patients Continuing Aspirin Therapy.
abstract: OBJECTIVE
  A clinical dilemma surrounds the use of aspirin therapy during laparoscopic partial nephrectomy. Despite reduced cardiac morbidity with perioperative aspirin use, fear of bleeding related complications often prompts discontinuation of therapy before surgery. We evaluate perioperative outcomes among patients continuing aspirin and those in whom treatment is stopped preoperatively.
  
  
  METHODS
  A total of 430 consecutive cases of laparoscopic partial nephrectomy performed between January 2012 and October 2014 were reviewed. Patients on chronic aspirin therapy were stratified into on aspirin and off aspirin groups based on perioperative status of aspirin use. Primary end points evaluated included estimated intraoperative blood loss and incidence of bleeding related complications, major postoperative complications, and thromboembolic events. Secondary outcomes included operative time, transfusion rate, length of hospital stay, rehospitalization rate and surgical margin status.
  
  
  RESULTS
  Among 101 (23.4%) patients on chronic aspirin therapy, antiplatelet treatment was continued in 17 (16.8%). Bleeding developed in 1 patient in the on aspirin group postoperatively and required angioembolization. Conversely 1 myocardial infarction was observed in the off aspirin cohort. There was no significant difference in the incidence of major postoperative complications, intraoperative blood loss, transfusion rate, length of hospital stay and rehospitalization rate. Operative time was increased with continued aspirin use (181 vs 136 minutes, p=0.01).
  
  
  CONCLUSIONS
  Laparoscopic partial nephrectomy is safe and effective in patients on chronic antiplatelet therapy who require perioperative aspirin for cardioprotection. Larger, prospective studies are necessary to discern the true cardiovascular benefit derived from continued aspirin therapy as well as better characterize associated bleeding risk.
authors.affiliation: Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York.
authors.forename: David A
authors.initials: DA
authors.lastname: Leavitt
authors.affiliation: Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York. Electronic address: uro.m.esmat@gmail.com.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Keheila
authors.affiliation: Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Siev
authors.affiliation: Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York.
authors.forename: Paras H
authors.initials: PH
authors.lastname: Shah
authors.affiliation: Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Moreira
authors.affiliation: Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York.
authors.forename: Arvin K
authors.initials: AK
authors.lastname: George
authors.affiliation: Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York.
authors.forename: Simpa S
authors.initials: SS
authors.lastname: Salami
authors.affiliation: Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Schwartz
authors.affiliation: Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York.
authors.forename: Lee
authors.initials: L
authors.lastname: Richstone
authors.affiliation: Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York.
authors.forename: Manish A
authors.initials: MA
authors.lastname: Vira
authors.affiliation: Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York.
authors.forename: Louis R
authors.initials: LR
authors.lastname: Kavoussi
mesh_terms: D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D016063:Blood Loss, Surgical; D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D009392:Nephrectomy / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D011183:Postoperative Complications / Q000139:chemically induced* / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: aspirin; kidney neoplasms; laparoscopy; nephrectomy