Statin use may reduce mortality risk, cardiac complications following noncardiac surgery

A retrospective, observational cohort study found that veterans who received statins on the day of and/or the day after noncardiac surgery had a lower 30-day all-cause mortality compared with those who did not receive statins.

Statin use was also associated with a reduced risk of other complications, including cardiac arrest and MI.

Lead researcher Martin J. London, MD, of the Department of Veterans Affairs Medical Center in San Francisco, and colleagues published their results online in JAMA Internal Medicine on Dec. 19.

The researchers analyzed 180,478 patients from the Veterans Affairs Surgical Quality Improvement Program who underwent neurosurgery and vascular, general, orthopedic, thoracic, urologic and otolaryngologic surgery from Oct. 1, 2005, to Sept. 30, 2010.

All patients were admitted to the hospital on the day of or within seven days of surgery and stayed in the hospital at least through the day after surgery. Patients were excluded if they died on the day of or the day after surgery.

The patients came from 104 Veterans Affairs hospitals and had a mean age of 63.8 years old. Of the patients, 95.6 percent were men, 29.2 percent were admitted before the day of surgery and 70.8 percent were admitted on the day of surgery.

The 30-day all-cause mortality rate was 2.2 percent, including 2.6 percent for vascular surgery, 3.2 percent for general surgery, 1.5 percent for orthopedic surgery and 1.8 percent for the other specialties.

In addition, 47.2 percent of patients were prescribed a statin within 90 days of hospital admission and 37.8 percent had an active prescription at the time of hospital admission. Only 0.9 percent of patients were prescribed a new statin within 14 days of admission.

The most common statin prescription was for simvastatin (80.8 percent of patients), while 59.5 percent of statin users had moderate-intensity dosing. Further, 31.5 percent of patients were exposed to a statin on the day of or the day after surgery.

The proportion of patients receiving statins increased from 35.5 percent in 2005 to 39.1 percent in 2010, while the proportion of patients receiving high-intensity doses increased from 7.1 percent to 10.6 percent. Meanwhile, the proportion of moderate-intensity doses increased from 21.7 percent to 22.7 percent and the proportion of low-intensity decreased from 6.7 percent to 5.8 percent.

The researchers also included 96,486 patients in a propensity-matched cohort. The mean age of those patients was 65.9 years old, and 96.3 percent were men.

Among the propensity-matched cohort, statin exposure on the day of or the day after surgery was associated with an 18 percent relative risk reduction in 30-day all-cause mortality, an 18 percent relative risk reduction in any complication and a 27 percent relative risk reduction for cardiac complications.

Subanalyses found that patients with ischemic heart disease or diabetes, those younger than 75 years old, those undergoing high-risk surgery and those receiving intensive statin therapy had a greater risk reduction with perioperative statin treatment, according to the researchers.

They added that the study had a few limitations, including that there were no specifics on the indications for prescription and the database did not capture drug administration. They also could not evaluate common adverse effects associated with statins, including elevated levels of creatine kinase, myalgia or liver transaminase.

“Perioperative statin use may be beneficial in reducing 30-day mortality, although the effects of selection biases cannot be excluded,” the researchers wrote.