title: Perioperative antiplatelet therapy and cardiovascular outcomes in patients undergoing joint and spine surgery.
abstract: OBJECTIVE
  Perioperative thrombotic complications after orthopedic surgery are associated with significant morbidity and mortality. The use of aspirin to reduce perioperative cardiovascular complications in certain high-risk cohorts remains controversial. Few studies have addressed aspirin use, bleeding, and cardiovascular outcomes among high-risk patients undergoing joint and spine surgery.
  
  
  METHODS
  We performed a retrospective comparison of adults undergoing knee, hip, or spine surgery at a tertiary care center during 2 periods between November 2008 and December 2009 (reference period) and between April 2013 and December 2013 (contemporary period).
  
  
  METHODS
  Patient demographics, comorbidities, management, and outcomes were ascertained using hospital datasets.
  
  
  RESULTS
  A total of 5690 participants underwent 3075 joint and spine surgeries in the reference period and 2791 surgeries in the contemporary period. Mean age was 61±13 years, and 59% were female. In the overall population, incidence of myocardial injury (3.1% vs 5.8%, P<.0001), hemorrhage (0.2% vs 0.8%, P=.0009), and red blood cell transfusion (17.2% vs 24.8%, P<.001) were lower in the contemporary period. Among 614 participants with a preoperative diagnosis of coronary artery disease (CAD), in-hospital aspirin use was significantly higher in the contemporary period (66% vs 30.7%, P<.0001); numerically, fewer participants developed myocardial injury (13.5% vs 19.3%, P=.05), had hemorrhage (0.3% vs 2.1%, P=.0009), and had red blood cell transfusion (37.2% vs 44.2%, P<.001) in the contemporary vs reference period.
  
  
  CONCLUSIONS
  In a large tertiary care center, the incidence of perioperative bleeding and cardiovascular events decreased over time. In participants with CAD, perioperative aspirin use increased and appears to be safe.
authors.affiliation: Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, New York, USA.
authors.forename: Nathaniel R
authors.initials: NR
authors.lastname: Smilowitz
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York, USA.
authors.forename: Brandon S
authors.initials: BS
authors.lastname: Oberweis
authors.affiliation: Department of Clinical Quality and Clinical Effectiveness, New York University School of Medicine, New York, New York, USA.
authors.forename: Swetha
authors.initials: S
authors.lastname: Nukala
authors.affiliation: Department of Anesthesiology, New York University School of Medicine, New York, New York, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Rosenberg
authors.affiliation: Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Stuchin
authors.affiliation: Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Iorio
authors.affiliation: Department of Orthopedic Surgery, New York University School of Medicine, New York, New York, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Errico
authors.affiliation: Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, New York, USA; Department of Population Health, New York University School of Medicine, New York, New York, USA.
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Radford
authors.affiliation: Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, New York, USA; Department of Surgery, Division of Vascular Surgery, New York University School of Medicine, New York, New York, USA. Electronic address: jeffrey.berger@nyumc.org.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Berger
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000401:mortality / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000401:mortality; D019990:Perioperative Care / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000453:epidemiology / Q000401:mortality; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: Antiplatelet; Aspirin; Bleeding; Cardiovascular; Coronary artery disease; Myocardial infarction; Myocardial injury; Orthopedic surgery; Perioperative; Transfusion