Association between pre-operative long-term aspirin use and post-operative outcomes following extracranial-intracranial bypass for moyamoya disease: National Inpatient Sample analysis.

OBJECTIVE

Moyamoya disease (MMD) carries significant morbidity. While management focuses on treatment with aspirin and Extracranial-intracranial (EC-IC) bypass, the impact of pre-operative long-term aspirin use on outcomes remains unclear. Our objective was to evaluate the association of long-term aspirin use with in-hospital outcomes in patients with MMD undergoing EC-IC bypass.

METHODS

We conducted a retrospective study using the National Inpatient Sample (2002-2020) to identify adult patients with MMD who underwent EC-IC bypass. Patients were stratified into 2 groups based on long-term aspirin use status at admission. Survey-weighted t-tests and Rao-Scott χ² were used to compare demographics and outcomes. Variables included complications, length of stay, total charges, and in-hospital mortality.

RESULTS

A total of 1453 weighted admissions were identified (72.8% female; mean age 43 ± 13 years), including 470 patients (32.3%) with and 983 (67.7%) patients without long-term aspirin use. The frequency of ischemic stroke-coded events during the index hospitalization was lower among long-term aspirin users (18.9% vs 27.9%; p < 0.001). Hemorrhagic stroke-coded events during the index hospitalization were low and similar between the groups (1.7% vs 3.5%; p = 0.088). Long-term aspirin users had shorter hospital stays (5.7 ± 0.4 vs 7.1 ± 0.3 days; p = 0.002) and fewer pulmonary complications (1.5% vs 3.6%; p = 0.04). In-hospital mortality did not differ significantly (8.3% vs 6.1%; p = 0.14).

CONCLUSION

Pre-operative long-term aspirin use in patients undergoing EC-IC bypass for MMD was associated with a lower frequency of ischemic stroke-coded events during the index hospitalization and shorter hospital stays without a significant increase in hemorrhagic complications. These findings suggest an association between long-term aspirin use and fewer ischemic stroke-coded events during the index hospitalization, although more clinically granular studies are needed before perioperative benefit can be inferred.