Perioperative Aspirin Continuation is Not Associated With Increased Surgical Morbidity Following Minimally Invasive Anterior-to-Psoas Lumbar Fusion: A Propensity-Matched Analysis

Retrospective cohort study with propensity score matching. To evaluate the impact of perioperative aspirin continuation on surgical and postoperative outcomes following minimally invasive anterior-to-psoas (MIS-ATP) lumbar fusion. Perioperative aspirin management in spine surgery remains controversial, with concerns centered on bleeding risk versus thrombotic complications associated with discontinuation. Evidence specific to minimally invasive lumbar fusion techniques, particularly the MIS-ATP approach, is limited. Adult patients who underwent MIS-ATP lumbar fusion with supplemental posterior percutaneous fixation at a single academic medical center (2014-2020) were included. Patients who continued low-dose aspirin through the perioperative period were compared with those who discontinued aspirin preoperatively. Propensity score matching (1:1 nearest-neighbor) incorporated age, sex, BMI, race/ethnicity, fusion levels, comorbidities (hypertension, diabetes mellitus, CAD, COPD, and CKD), smoking, alcohol use, and preoperative laboratory values. Primary outcomes included operative time, estimated blood loss (EBL), postoperative day-1 hemoglobin, and length of stay. A subanalysis compared aspirin continuers with patients who held aspirin ≥7 days preoperatively. Of 455 eligible patients, 134 (29.5%) continued aspirin and 321 (70.5%) discontinued. Propensity matching yielded 86 well-balanced pairs (n=172). Operative time (224.7±97.9 vs . 228.6±90.1 min; P =0.79), EBL (244.4±456.0 vs . 278.4±418.7 mL; P =0.62), postoperative day-1 hemoglobin (10.88±1.49 vs . 11.08±1.76 g/dL; P =0.41), and length of stay (4.83±3.72 vs . 4.20±2.49 d; P =0.22) did not differ significantly. Transfusion rates (18.6% vs . 15.1%; P =0.54) and retroperitoneal hematoma (1.2% vs . 1.2%; P =1.00) were comparable. The ≥7-day-hold subanalysis (15 matched pairs) showed no outcome advantage over continuation. Perioperative continuation of low-dose aspirin in appropriately selected patients undergoing MIS-ATP lumbar fusion was not associated with increased surgical morbidity or postoperative complications, supporting an individualized, approach-specific approach to perioperative antiplatelet management.