Abstract: PD30-04
Sources of Funding: None

Introduction

The recently published American Urological Association guidelines on the surgical management of kidney stones state that ureteroscopy (URS) is the preferred treatment for patients on continuous antiplatelet regimens, however multiple recent case series questioned whether continuing low-dose aspirin at the time of percutaneous nephrolithotomy (PCNL) or extracorporeal shockwave lithotripsy (ESWL) could be safe in certain settings. We conducted a survey study to further define current practice trends and guide future research into the topic.

Methods

An electronic survey was sent to approximately 2000 members of the Endourology Society in September of 2016. 184 substantive responses (9.2%) were received from members in six continents. The resulting data was analyzed and associations were measured by Pearson's chi-squared test.

Results

63% of respondents were fellowship trained, 67% practiced in academic centers, and 70% practiced in North America or Europe. 79% of respondents stated that they routinely performed URS on patients taking 81 mg of Aspirin (ASA) daily as opposed to only 29% when asked the same question with regard to PCNL (Odds Ratio (OR): 17.4, p < 0.001) and 18% with regard to ESWL (OR: 9.2, p < 0.001). Those in academic practice were more likely to perform PCNL (OR: 2.4, p = 0.02) but not ESWL (p = 0.51) on patients while taking ASA. Respondents from outside North America or Europe rarely reported performing PCNL or ESWL on patients taking ASA (40% vs. 5%, p <0.001 and 22% vs 7%, p = 0.01). Neither fellowship training nor high case volumes were associated with an increased likelihood of performing PCNL or ESWL in patients taking ASA; however if a surgeon performed fellowship training in North America or Europe, they were significantly more likely to routinely perform PCNL on patients taking ASA (p <.0001). Those who performed PCNL or ESWL on ASA were significantly less likely to consult cardiology regarding cessation of ASA pre-operatively (p <.001). There was a trend toward younger physicians performing PCNL and ESWL on ASA (p = 0.06, 0.05, respectively).

Conclusions

Urologists commonly perform URS in patients taking aspirin, but only a minority perform ESWL and PCNL in patients on ASA. There was a wide regional variation in aspirin usage in ESWL. Surgeons in academic centers and with fellowship training from North America or Europe were more likely to perform PCNL on ASA. The next step is to evaluate the safety and outcomes of remaining on ASA for surgery.

Funding

None