Risky business? Investigating outcomes of patients undergoing urgent laparoscopic appendectomy on antithrombotic therapy

• Published in: The American journal of surgery 2017-12, Vol.214 (6), p.1012-1015
• Main Authors: Pearcy, Christopher, Almahmoud, Khalid, Jackson, Theresa, Hartline, Cassie, Cahill, Anthony, Spence, Lara, Kim, Dennis, Olatubosun, Oluwabukola, Todd, S. Rob, Campion, Eric M., Burlew, Clay Cothren, Regner, Justin, Frazee, Richard, Michaels, David, Dissanaike, Sharmila, Stewart, Collin, Foley, Neal, Nelson, Paul, Agrawal, Vaidehi, Truitt, Michael S.
• Format: Article
• Language: English
• Subjects: Abdomen; Acute care surgery; Adult; Age; Antiplatelet; Antithrombotic; Appendectomy; Appendicitis; Appendicitis - mortality; Appendicitis - surgery; Aspirin; Aspirin - administration & dosage; Blood Loss, Surgical - statistics & numerical data; Blood transfusion; Blood Transfusion - statistics & numerical data; Cardiovascular disease; Cholecystectomy; Clinical trials; Clopidogrel; Comorbidity; Complications; Epidemiology; Female; Fibrinolytic Agents - administration & dosage; Hospitals; Humans; Infections; Infectious diseases; Institutions; Joint surgery; Laparoscopic appendectomy; Laparoscopy; Length of Stay - statistics & numerical data; Male; Middle Aged; Mortality; Patient Readmission - statistics & numerical data; Patients; Platelet Aggregation Inhibitors - administration & dosage; Polypharmacy; Postoperative Complications - epidemiology; Retrospective Studies; Subgroups; Surgery; Surgical site infections; Surgical Wound Infection - epidemiology; Therapy; Ticlopidine - administration & dosage; Ticlopidine - analogs & derivatives; Transfusion; Treatment Outcome; United States - epidemiology
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2017.08.035

The literature regarding outcomes in patients on irreversible antithrombotic therapy (IAT) undergoing urgent laparoscopic appendectomy is limited. The aim of this multicenter retrospective study was to examine the impact of prehospital IAT on outcomes in this population. From 2010 to 2014, seven institutions from the Southwest Surgical Multicenter Trials (SWSC MCT) group conducted a retrospective study to evaluate the clinical course of all patients on IAT who underwent urgent/emergent laparoscopic appendectomy. The IAT+ group was subdivided into IAT+ (Aspirin only) and IAT+ (Aspirin-Plavix). These groups were matched 1:1 to controls. The primary outcomes were estimated blood loss (EBL) and transfusion requirement. Secondary outcomes included infections (SSI – Surgical Site Infection, DSI – Deep Space Infection, and OSI – Organ Space Infection), hospital length of stay (HLOS), complications, 30-day readmissions, and mortality. Out of the 2903 patients included in the study, 287 IAT+ patients were identified and matched in a 1:1 ratio to 287 IAT-patients. In the IAT+ vs IAT-analysis, no significant differences in EBL (p = 1.0), transfusion requirement during the preoperative (p = 0.5), intraoperative (p = 0.3) or postoperative periods (p = 0.5), infectious complications (SSI; p = 1.0, DSI; p = 1.0, and OSI; p = 0.1), overall complications (p = 0.3), HLOS (p = 0.7), 30-day readmission (p = 0.3), or mortality (p = 0.1) were noted. Similarly, outcomes in the IAT+ (Aspirin only) and IAT+ (Aspirin-Plavix) subgroups failed to demonstrate any significant differences when compared to controls. Our analysis suggests that IAT is not associated with worse outcomes in urgent/emergent laparoscopic appendectomy. Prehospital use of IAT should not be used to delay laparoscopic appendectomy.