344 Effects of Discontinuance of Preoperative Antiplatelet Medication in Multilevel Thoracolumbar Spine Surgery.

INTRODUCTION: The aims of our study were to evaluate the perioperative morbidities of patients who were taking antiplatelet medication in multilevel thoracolumbar spine surgery.

METHODS: We retrospectively reviewed the medical records of 147 patients who underwent multilevel spine surgery from January 2009 to November 2014 at our institution. Cervical spine surgery and simple lumbar laminectomy operations were excluded. These patients were divided into 2 groups based on the preoperative antiplatelet medication. The antiplatelet group (n = 13) discontinued the anticoagulation therapy 7 days before the spine surgery was performed. Control group (n = 134) did not use any antiplatelet medication. Age, body mass index (BMI), medical history, operation time, intraoperative estimated blood loss, ASA score, and transfusion of blood products were assessed. The incidence of postoperative major complications such as the spinal epidural hematoma and operative site infection were also compared.

RESULTS: The overall postoperative complication rates were similar in 2 groups. The incidences of major complication rates were 7.7% (1/13) for antiplatelet groups, 9.7% (13/134) for control groups. In antiplatelet groups, 1 patient experienced surgical site infection and a revision operation was performed. This complication has no relationship with bleeding tendency. Severe bleeding-related complication in the perioperative period did not appear in both groups. Multiple logistic regression analysis demonstrated that BMI and estimated intraoperative blood loss are independent predictors of operation-related complications. In consideration of intraoperative parameters such as estimated intraoperative blood loss and intraoperative transfusion rates, the amount of intraoperative bleeding loss in the control group is more severe.

CONCLUSION: Surgical complication-related perioperative bleeding had serious influences on the surgical outcome. So, spine surgeons have been reluctant to perform multilevel spine surgery on the patients who are taking anticoagulant medications. According to our study, the preoperative anticoagulant therapy did not increase the bleeding-related complications, and spine operations can be performed relatively safely if we try to carefully consider the comorbidities of patients.