Outcome and Complications in Patients Undergoing Non-Instrumented Extradural Spine Surgery Treated with Low-dose Acetylsalicylic Acid: A Comparative Study

Aim: Coronary artery disease (CAD) affects over one third of adults and is the leading cause of overall mortality and morbidity. Acetylsalicylic acid (ASA) is widely used in the prevention of CAD. As the population continues to mature, the amount of patients presenting for spinal surgery under ASA treatment is rising. Studies investigating the outcome of spine surgeries without discontinuing ASA therapy are lacking. In this study we compare, the peri- and postoperative bleeding and cardiovascular complication rates of patients undergoing non-instrumented extradural spine surgery without discontinuing low dose ASA, with patients in which low dose ASA was discontinued.

Methods: We retrospectively compared the intra- and postoperative blood loss, morbidity, mortality, blood transfusion requirement and hematologic findings in the ASA group (40 patients) with the control group (62 patients). The diagnosis in all patients was either lumbar disc herniation or spinal canal stenosis.

Results: Intraoperative blood loss was 221 ml in the ASA group and 140.16 ml in the control group, showing no statistical difference (p=.08). The postoperative blood loss was 146.58 ml and 167.97 ml in the ASA and control group respectively, showing no statistical difference either (p=.76). In the ASA group one patient showed a postoperative epidural hematoma needing revision surgery, while in the control group no postoperative epidural hematoma was seen (p=.40). In addition blood transfusion requirements, hematologic findings, morbidity and mortality showed no significant difference.

Conclusion: The continuation of ASA treatment in patients undergoing non-instrumented extradural spinal surgery is safe and its perioperative continuation is therefore recommended.