gms | German Medical Science

Objective: The impact of perioperative aspirin medication (pASS) for secondary prophylaxis of cardiovascular events on bleeding complication during spinal surgery (SS) remains unclear. A growing body of evidence emerges, that cessation of pASS may lead to cardiovascular complications or recurrent stroke. Therefore a multicentre ASS registry was established for patients undergoing SS.

Method: Preliminary data of the registry are evaluated. For patients with pASS centres were asked to acquire data and fulfil a standard form, which was centrally collected. From April 2013 to November 2013 a total of 4994 operative procedures were performed in 35 Departments. Data were collected from routine data (operative procedure code, OPS) for 5 different procedures. Patients with single or multilevel surgery e.g. interlaminar fenestration (ILF, OPS 5-831.X), decompression of the lumbar spinal canal (LD, OPS 5-839.6), posterior interbody fusion (PLIF, OPS 5-83b.4), anterior cervical fusion or arthroplasty (ACS, OPS 5-83b.7/ 5-839.X) or posterior decompression of the cervical spine (PCS, OPS 5-839.6) were collected. Outcome analysis included patients with postoperative hematoma, who required revision surgery and patients with any of these events: acute myocardial infarction, stroke or arterial vascular complications. Perioperative interventions were registered if they were necessary to achieve safe haemostasis.

Results: 34 patients were operated while on pASS (8 [23,5%], 6 [17,6%], 7 [20,6%], 5 [14,7%] and 8 [23,5%] procedures for ILF, LD, PLIF, ACS and PCS respectively). Indication for pASS was coronary artery disease (n=26 [76,5%]), peripheral vascular disease (n=3 [8,8%]) and previous stroke (n=5 [14,7%]). 1 patient (2,9%) suffered from postoperative bleeding which required second surgery and 1 patient, who underwent PLIF surgery required transfusion of 2 erythrocyte concentrates. None of the patients required an intervention for pASS reversal. No cardiovascular or neurovascular complications occurred in this small series. Low molecular weight heparin (LMWH) prophylaxis was initiated within 24h in 21 patients and within 48h after surgery in the remaining 13 patients.

Conclusions: Although the number of patients included in the registry is small major bleeding complications were rare, when LMWH prophylaxis was initiated postoperatively. Data collection has to be continued and a larger patient number is required to proof the safety of SS for patients on pASS.