title: Is preoperative withdrawal of aspirin necessary in patients undergoing elective inguinal hernia repair?
abstract: Antiplatelets such as aspirin are widely used to reduce thrombotic events in patients with various cardiovascular comorbidities. Continuing aspirin through noncardiac surgery has been shown to reduce risk of major adverse cardiac events (MACE) but may lead to higher bleeding complications. Inguinal hernia repair is a commonly performed surgical procedure among such patients, but no guideline exists regarding perioperative use of aspirin.
  
  
  
  We aim to investigate the safety profile of aspirin continuation in the perioperative period in patients undergoing elective primary inguinal hernia repair.
  
  
  
  All patients who underwent elective primary inguinal hernia repair from 2008 to 2015 and were on aspirin preoperatively were identified. The patients were divided into two groups: those who continued aspirin through the morning of the operation and those who were advised to stop aspirin therapy 3-7 days prior to operation. All patients underwent either open Lichtenstein mesh repair or laparoscopic total extra-peritoneal mesh repair. Outcomes measured include intraoperative blood loss, operative time, bleeding complications, wound site complications and MACE.
  
  
  
  Among 1841 patients who underwent elective primary inguinal hernia mesh repair, 142 (7.7 %) patients were on preoperative aspirin. Fifty-seven patients underwent laparoscopic repair, while 85 underwent open mesh repair. Twenty-seven out of fifty-seven (47.3 %) from the laparoscopic group and 55/85 (64.7 %) from the open group were instructed to stop aspirin (p = 0.040). There were no significant differences between those who stopped aspirin and those who continued in terms of intraoperative blood loss and operative timing. Immediate postoperative bleeding complications and follow-up wound complications were also similar between the two groups. Overall, there were no MACE among those who underwent laparoscopic repair. Three MACE were recorded in the open group (2 stopped vs. 1 continued; p = 0.943). There was no perioperative mortality.
  
  
  
  Continuation of aspirin is safe and should be preferred in patients with higher cardiovascular risk.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. prooyf@hotmail.com.
authors.forename: Wilson
authors.initials: W
authors.lastname: Ong
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Tong
authors.initials: T
authors.lastname: Shen
authors.affiliation: Department of Surgery, Minimally Invasive Surgical Centre, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Wee Boon
authors.initials: WB
authors.lastname: Tan
authors.affiliation: Department of Surgery, Minimally Invasive Surgical Centre, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Davide
authors.initials: D
authors.lastname: Lomanto
mesh_terms: D000328:Adult; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data; D004334:Drug Administration Schedule; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D019990:Perioperative Care / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D011183:Postoperative Complications / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D028761:Withholding Treatment
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: Antiplatelets; Aspirin; Inguinal hernia; Repair