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

Christopher Pearcy, Khalid Almahmoud, Theresa Jackson, Cassie Hartline, Anthony Cahill, Lara Spence, Dennis Kim, Oluwabukola Olatubosun, S. Rob Todd, Eric M. Campion, Clay Cothren Burlew, Justin Regner, Richard Frazee, David Michaels, Sharmila Dissanaike, Collin Stewart, Neal Foley, Paul Nelson, Vaidehi Agrawal, Michael S. Truitt

Research output: Contribution to journalArticle

Abstract

Introduction 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. Methods 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. Results 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. Conclusions 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.

Original languageEnglish (US)
Pages (from-to)1012-1015
Number of pages4
JournalAmerican Journal of Surgery
Volume214
Issue number6
DOIs
StatePublished - Dec 1 2017
Externally publishedYes

Fingerprint

Appendectomy
clopidogrel
Aspirin
Therapeutics
Length of Stay
Multicenter Studies
Retrospective Studies
Infection
Surgical Wound Infection
Mortality
Group Psychotherapy
Postoperative Period
Blood Transfusion
Research Design

Keywords

  • Acute care surgery
  • Antiplatelet
  • Antithrombotic
  • Appendicitis
  • Laparoscopic appendectomy

ASJC Scopus subject areas

  • Surgery

Cite this

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

In: American Journal of Surgery, Vol. 214, No. 6, 01.12.2017, p. 1012-1015.

Research output: Contribution to journalArticle

Pearcy, C, Almahmoud, K, Jackson, T, Hartline, C, Cahill, A, Spence, L, Kim, D, Olatubosun, O, Todd, SR, Campion, EM, Burlew, CC, Regner, J, Frazee, R, Michaels, D, Dissanaike, S, Stewart, C, Foley, N, Nelson, P, Agrawal, V & Truitt, MS 2017, 'Risky business? Investigating outcomes of patients undergoing urgent laparoscopic appendectomy on antithrombotic therapy', American Journal of Surgery, vol. 214, no. 6, pp. 1012-1015. https://doi.org/10.1016/j.amjsurg.2017.08.035
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. / Risky business? Investigating outcomes of patients undergoing urgent laparoscopic appendectomy on antithrombotic therapy. In: American Journal of Surgery. 2017 ; Vol. 214, No. 6. pp. 1012-1015.
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AU - Pearcy, Christopher

AU - Almahmoud, Khalid

AU - Jackson, Theresa

AU - Hartline, Cassie

AU - Cahill, Anthony

AU - Spence, Lara

AU - Kim, Dennis

AU - Olatubosun, Oluwabukola

AU - Todd, S. Rob

AU - Campion, Eric M.

AU - Burlew, Clay Cothren

AU - Regner, Justin

AU - Frazee, Richard

AU - Michaels, David

AU - Dissanaike, Sharmila

AU - Stewart, Collin

AU - Foley, Neal

AU - Nelson, Paul

AU - Agrawal, Vaidehi

AU - Truitt, Michael S.

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N2 - Introduction 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. Methods 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. Results 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. Conclusions 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.

AB - Introduction 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. Methods 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. Results 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. Conclusions 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.

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