Surgical resection of cutaneous head and neck lesions: does aspirin use increase hemorrhagic risk?

OBJECTIVE To determine whether the antiplatelet agent aspirin increases hemorrhagic risk in patients undergoing surgical resection of cutaneous head and neck lesions. DESIGN Retrospective cohort study. SETTING Regional referral center. Patients All cases of cutaneous head and neck lesions surgically resected during a 10-year period were included. MAIN OUTCOME MEASURES Outcome measures were incidence of significant postoperative hemorrhage, defined as postoperative hematoma or hemorrhage necessitating surgical reexploration; and total postoperative hemorrhage, defined as any hemorrhage lasting longer than 4 hours despite external pressure, requiring medical review, and resulting in prolongation of the patient's hospital stay or readmission to the hospital. RESULTS Seven hundred eleven patients (974 cases) were eligible for inclusion, of whom 320 were receiving aspirin therapy at the time of surgery. The incidence of significant postoperative hemorrhage in the aspirin and nonaspirin groups was 5 (1.6%) and 0, respectively (P = .004), and aspirin use was the only risk factor for significant postoperative hemorrhage. The incidence of total postoperative hemorrhage in the aspirin and nonaspirin groups was 7 (2.2%) and 1 (0.1%), respectively (P = .002). At multivariate analysis, aspirin use and local flap reconstruction were independent risk factors for total postoperative hemorrhage. Cases receiving aspirin therapy who also underwent local flap reconstruction were at exponential (124-fold) increased risk of total postoperative hemorrhage compared with cases with neither risk factor. CONCLUSIONS Aspirin intake at the time of surgery to resect cutaneous head and neck lesions confers a small but statistically increased risk of postoperative hemorrhage. This risk is particularly pronounced in patients undergoing local flap reconstruction.