698 Background: Increasing cardiovascular disease has led to increases in the patient population on anti-platelet therapy who require urologic surgery. We sought to study perioperative outcomes for those undergoing partial nephrectomy (PN) while taking or not taking perioperative aspirin (pASA). Methods: A retrospective review of those undergoing PN was performed on the Premier Hospital Database from 2003 to 2015, with survey projection weighting resulting in a cohort of 10,807 patients. Two groups were formed – those continued on pASA (group 1, n = 774) and those with no pASA (group 2, n = 10,033). In-hospital complication rates were studied: major bleeding, overall transfusion, day-of-surgery transfusion, prolonged ( > 4 days) length of stay (LOS), and prolonged ( > 285 minutes) operative time. We also assessed 90-day rates of: cardiovascular catastrophe, readmission, major complication, and DVT/PE. Unadjusted rates were calculated for all PN patients and further subdivided into open and minimally invasive PN. Adjusted odds ratios (OR) were then calculated between groups 1 and 2. Results: Group 1 was older (58% vs 38% ≥65 years, p < 0.0001), largely male (73.1% vs 58.7%, p = 0.001), and less healthy (34.8% vs 18.4% with a CCI score ≥2, p = 0.003) than to group 2. For in-hospital outcomes, no significant differences were noted. Stratifying by surgical approach, those in group 1 undergoing minimally invasive PN were slightly less likely to require a day-of-surgery transfusion (OR 0.29, CI [0.05-0.99], p < 0.05). For 90-day outcomes, group 1 were far more likely to suffer a cardiovascular catastrophe (OR 7.56, CI [3.38-16.92], p < 0.001) regardless of surgical approach. Conversely, group 1 was slightly less likely to experience readmission (OR 0.48, CI [0.24-0.94], p < 0.05) and was likely driven by those undergoing minimally invasive PN. Conclusions: This large review of academic and community hospitals provides insight into the impact perioperative ASA has on PN outcomes. As noted, in-hospital outcomes were largely equivalent between groups while 90-day cardiovascular catastrophe rates were much higher in the ASA group. Despite this, this study lends support to the belief that pASA should not be considered an absolute contraindication to PN.
The impact of tumor differentiation on perioperative outcomes and patterns of recurrence following preoperative therapy for resectable pancreatic adenocarcinoma
