Risk of aspirin continuation in spinal surgery: a systematic review and meta-analysis

BACKGROUND CONTEXT: Aspirin is typically discontinued in spinal surgery because of increased risk of hemorrhagic complications. The risk of perioperative continuation of aspirin in neurosurgery needed to be evaluated. PURPOSE: This study aimed to evaluate all available evidence about continuation of aspirin and to compare peri-and postoperative blood loss and complication rates between patients that continued aspirin and those who discontinued aspirin perioperatively in spinal surgery. STUDY SETTING: Systematic review and meta-analysis were carried out. METHOD: A meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing aspirin continuation with discontinuation were included. Studies using a combination of anticlotting agents or nonspinal procedures were excluded. Operative outcomes (blood loss and operative length) and different complications (surgical site infection [SSI]), stroke, myocardial infarction within 30 days postoperatively) were extracted. Overall prevalence and means were calculated for the reported outcomes in fixed-effects models with heterogeneity (I-squared [I-2]) and effect modification (P-interaction) assessment. RESULTS: Out of 1,339 studies, three case series were included in the meta-analysis. No significant differences in mean operating time were seen between the aspirin-continuing group (mean= 201.8 minutes, 95% confidence interval [CI]= 193.3; 210.3; I-2= 95.4%; 170 patients) and the aspirindiscontinuing group (mean= 178.4 minutes, 95% CI= 119.1; 237.6; I-2= 93.5%; 200 patients); (Pinteraction= 0.78). No significant differences in mean perioperative blood loss were seen between the aspirin-continuing group (mean= 553.9 milliliters, 95% CI= 468.0; 639.9; I-2= 83.4%; 170 patients) and the aspirin-discontinuing group (mean= 538.7 milliliters, 95% CI= 427.6; 649.8; I(2)d= 985.5%; 200 patients); (P-interaction= 0.96). Similar non-significant differences between the two groups were found for cardiac events, stroke, and surgical site infections. CONCLUSIONS: This meta-analysis showed an absence of significant differences in perioperative complications between aspirin continuation and discontinuation. Because of the paucity of included studies, further well-designed prospective trials are imperative to demonstrate potential benefit and safety. (C) 2017 Elsevier Inc. All rights reserved.