CLINICAL QUESTION: Does perioperative statin use reduce 30-day mortality in noncardiac surgery?
BACKGROUND: Current perioperative guidelines focus on continuation of existing therapy in long-term statin users with weak recommendations of potential efficacy in reducing perioperative complications.
STUDY DESIGN: Retrospective, observational cohort analysis.
Dr. Caitlin Dietsche
Setting: Veterans’ Affairs Hospitals.
SYNOPSIS: Using the Veterans Affairs Surgical Quality Improvement Program database, 96,486 patients were studied who were undergoing elective or emergent noncardiac surgery (vascular, general, orthopedic, neurosurgery, otolaryngology, and urology). 96.3% were men. Patients who died the day of the surgery or the day after were excluded, as were patients with multiple surgeries during the assessment period. Statin exposure on the day of or the day after surgery was compared with no statin use. The primary outcome was 30-day mortality and the secondary outcomes were significant reduction in any other complication.
Statin exposure was associated with reduced 30-day all-cause mortality with a marginally favorable effect with longer-term statin use (6 months to 1 year before admission). For the secondary outcomes, there was significant risk reduction in cardiac, infectious, respiratory, and renal complications but no significant change in central nervous system or nonatherosclerotic thrombotic complications.
Statin exposure may be associated with adherence to medical treatment and follow-up thus causing a selection bias.
BOTTOM LINE: Perioperative statin use was associated with a reduction in 30-day mortality and other complications.
CITATIONS: London MJ, Schwartz GG, Hur K, Henderson WG. Association of perioperative statin use with mortality and morbidity after major noncardiac surgery. JAMA Intern Med. 2017 Feb 1;177(2):231-42.
Dr. Dietsche is a clinical instructor, Division of Hospital Medicine, University of Colorado School of Medicine, Aurora.