Preoperative Statin Use and 90-Day Mortality After Noncardiac Surgery

Abstract

Objective: The aim of this study was to investigate the association between preadmission statin use and 90-day mortality after planned elective noncardiac surgery in adult patients. Summary Background Data: Statin therapy is known to have pleiotropic effects, which improve the outcomes of various diseases. However, the effect of perioperative statin therapy on postoperative mortality remains controversial. Methods: This retrospective cohort study analyzed the medical records of adult patients who were admitted to a single tertiary academic hospital for elective noncardiac surgery between January 2012 and December 2018. The primary endpoint was 90-day mortality, which was defined as any mortality within 90 days after surgery. The secondary endpoint was overall survival. Results: After propensity score matching, a total of 33,514 patients (16,757 patients in each group) were included in the analysis. The logistic regression analysis of the propensity score-matched cohort indicated that the odds ratio (OR) of 90-day mortality in the statin group was 26% lower than that of the nonstatin group [OR: 0.74; 95% confidence interval (CI): 0.59 to 0.92; P ¼ 0.009]. The sensitivity analysis indicated that the high-dose intensity statin group had a 61% lower 90-day mortality rate than the nonstatin group (OR: 0.39; 95% CI: 0.18-0.84; P ¼ 0.016). The overall survival time was significantly longer in the statin group than in the nonstatin group after propensity score matching (P < 0.001 by log-rank test). Conclusions: Preoperative statin use was associated with lower 90-day mortality and longer overall survival for adult patients who underwent elective noncardiac surgery. This association was more evident for high-intensity statin users.

Guideline adherence to statin therapy and association with short-term and long-term cardiac complications following noncardiac surgery

“…Fourth, the use of statins was associated with a reduced risk of MACE within 120 days with a weighted hazard ratio in patients with statin therapy of 0.59 (95% CI 0.41 to 0.86). This important observation strengthens prior studies suggesting a possible reduction of long-term cardiac complications by statins 17–20,40 . A meta-analysis of 12 rather small randomised controlled trials overall involving 4707 patients undergoing noncardiac surgery showed a neutral effect on all-cause and cardiovascular mortality but a reduction in MI during follow-up (OR 0.46) in patients treated with statins compared with the control group 19 .…”

“…In a large prospective cohort study, the use of statins was associated with a reduction in all-cause mortality; RR was 0.58 and for cardiovascular mortality 0.42 20 . Another retrospective cohort study found a positive effect of statin therapy on 90-day mortality (OR 0.74) 40 . In our cohort, the ARR of 1.7% would indicate a NNT of 59 for events within 120 days.…”

“…20 Another retrospective cohort study found a positive effect of statin therapy on 90-day mortality (OR 0.74). 40 In our cohort, the ARR of 1.7% would indicate a NNT of 59 for events within 120 days. This adds to the already known beneficial effects of statins that lead to a class I recommendation for their use in this group.…”

“…This important observation strengthens prior studies suggesting a possible reduction of long-term cardiac complications by statins. [17][18][19][20]40 A meta-analysis of 12 rather small randomised controlled trials overall involving 4707 patients undergoing noncardiac surgery showed a neutral effect on all-cause and cardiovascular mortality but a reduction in MI during follow-up (OR 0.46) in patients treated with statins compared with the control group. 19 In a large prospective cohort study, the use of statins was associated with a reduction in all-cause mortality; RR was 0.58 and for cardiovascular mortality 0.42.…”

Comment on “Preoperative Statin Use and 90-day Mortality After Noncardiac Surgery”

“…With great interest, we read the retrospective cohort study by Im et al, 1 which evaluated the association between preoperative statin use and intermediate-term survival after noncardiac surgery. They performed statistical analyses in a robust and sophisticated manner with sensitivity analyses.…”