Use of Statins in Adhesive Small Bowel Obstruction

Srinivasa, Sanket; Kahokehr, Arman; Sammour, Tarik; Yu, Tzu-Chieh; Abbas, Saleh; Hill, Andrew G.

doi:10.1016/j.jss.2010.02.028

Cited by 9 publications

(5 citation statements)

References 42 publications

(52 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another possibility is that while barrier methods may not have an effect on rates of SBO, these agents may influence the clinical course of SBO, reducing the need for surgical intervention. Furthermore, unmeasured effects of various medications prescribed for other medical conditions could potentially limit the need for such procedures via idiosyncratic effects on the course of adhesion-related SBO 23 . These hypotheses should be assessed in future studies.…”

Section: Discussionmentioning

confidence: 99%

Secular trends in small-bowel obstruction and adhesiolysis in the United States: 1988–2007

Scott

Osterman

Mahmoud

et al. 2012

The American Journal of Surgery

View full text Add to dashboard Cite

Background Post-operative adhesions are common following surgery and can cause small bowel obstruction (SBO) and require adhesiolysis. The impact that laparoscopy and other surgical advances have had on rates of SBO and adhesiolysis remains controversial. This study examines trends in discharges from US hospitals for SBO and adhesiolysis from 1988–2007. Methods We performed an analysis of secular trends for SBO and adhesiolysis, utilizing the National Hospital Discharge Survey (NHDS). Spearman correlation coefficients were calculated to assess trends over time. Results Rates of SBO were stable over time (ρ=0.140, p=0.28). Adhesiolysis rates were stable over time (ρ=−0.18, p=0.17, though there were significant downward trends in those >65 (ρ=−0.55, p=0.01) and 15–44 (ρ=−0.84, p<0.01). Conclusions There has been no significant change in overall rates of SBO or adhesiolysis from 1988–2007. For adhesiolysis, there were decreasing trends when stratified by age. Further research is required to understand the factors associated with adhesion-related complications.

show abstract

Section: Discussionmentioning

confidence: 99%

Secular trends in small-bowel obstruction and adhesiolysis in the United States: 1988–2007

Scott

Osterman

Mahmoud

et al. 2012

The American Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…Of these, 58 studies that did not align with the aim of our meta-analysis were excluded following a review of the titles and abstracts. The full texts of the remaining 13 studies were reviewed in detail, and 4 studies were excluded for the following reasons: oral use of statins (n = 3) 20 – 22 and use in clinical setting (n = 1) 23 .…”

Section: Resultsmentioning

confidence: 99%

“…Thus, for ethical reasons, randomized controlled studies are not possible. Only one study of retrospective data, which examined 419 patients admitted with intraperitoneal adhesion in one institution, reported that history of statin use significantly reduced the need for reoperation 23 .…”

Section: Discussionmentioning

confidence: 99%

Effect of statins on experimental postoperative adhesion: a systematic review and meta-analysis

Choi

Park

Kim

et al. 2018

Sci Rep

View full text Add to dashboard Cite

Adhesion is a significant concern after surgery. Many researchers studied the anti-adhesive effect of statin, of which results were inconsistent. Thus, we purposed to perform a systematic review and meta-analysis to evaluate the effect of statins on postoperative adhesion in an experimental study. A comprehensive search was conducted using MEDLINE, EMBASE, and Google Scholar to identify animal studies that investigated the postoperative anti-adhesive effect of statins applied at the surgical area. Primary outcome measure was gross adhesion score. Secondary outcomes included microscopic adhesion score and tissue plasminogen activator (t-PA) activity. Totally, 298 rats from 9 animal studies (172 rats received statin therapy and 126 rats received placebo or no treatment) were included in the final analysis. The combined results showed that gross and microscopic adhesion scores were significantly lower in the statin group in comparison to the control group (standardized mean difference [SMD] = 1.65, 95% confidence interval [CI]: 1.02 to 2.28, Pchi2 < 0.001, I2 = 77.9%; SMD = 1.90, 95% CI: 1.10 to 2.79, Pchi2 < 0.001, I2 = 84.5%, respectively). However, there was no evidence of a difference in t-PA activity (SMD = −3.43, 95% CI: −7.95 to 1.09, Pchi2 < 0.001, I2 = 95.5%). In conclusion, statins were effective in preventing postoperative adhesion, as assessed based on gross and microscopic adhesion scores in rats.

show abstract

“…Additionally, while statins are inexpensive and well tolerated, it is important to assess the cost-effectiveness of statins and financial implications for patients. In the setting of adhesive SBOs, patients receiving statin therapy were more likely to be successfully treated nonoperatively, suggesting potential cost and outcome benefits to patients and insurers . Keeping this in mind, the work by Scott and colleagues affirms that statins are a promising avenue for reducing the risk of ARCs and lays the groundwork for future clinical trials to further validate these findings.…”

mentioning

confidence: 97%

Are Statins Associated With Reduced Risk of Adhesion-Related Complications After Abdominal Surgery?

Yelorda

Knowlton

2021

JAMA Netw Open

View full text Add to dashboard Cite

Adhesions are the result of intra-abdominal scar tissue that can form after abdominal or pelvic surgery. Despite advances in surgical technique and extensive research devoted to their prevention, adhesions remain the most common cause of small bowel obstructions (SBOs), accounting for 56% of SBOs. 1 It is estimated that more than 90% of patients who undergo abdominal or pelvic surgery will develop postoperative adhesions. Additionally, adhesions can cause chronic pain, infertility, and increased complexity of subsequent intra-abdominal operations. Considerable time and effort have been devoted to devising methods to prevent adhesions, from modifications in surgical technique to the development of mechanical barriers or chemical compounds. To date, none of these methods have been proven to eliminate the incidence of adhesion-related complications (ARCs).The development of adhesions after abdominal surgery is mediated by inflammatory pathways involving cyclooxygenase enzymes and other profibrotic cytokines. Although numerous barriers derived from various forms of polysaccharides have shown some success in lowering rates of ARCs, some may be associated with higher risk of surgical site infection. 2 Thus, there has been an increased focus on the inflammatory pathway leading to adhesions as a potential target for adhesion prevention. Statins have been used for decades to lower low-density lipid cholesterol by inhibiting 3-hydroxy-3-methylglutaryl coenzyme reductase. Animal and cell studies have demonstrated statins also have anti-inflammatory effects by downregulating proinflammatory cytokines. 3 However, the association of statin use with postoperative ARCs in humans has not been studied prior to the article by Scott and colleagues. 4 Current innovations in adhesion prevention, ranging from laparoscopic and surgical techniques to adhesion barriers, have been shown to reduce ARCs. 2,5 However, these methods may not be applicable to all operative settings, such as emergent surgery or a contaminated surgical field.Pharmacological treatments present another option to prevent adhesions. While new drugs require considerable resources, time, and cost to bring to market, Scott and colleagues 4 present a valuable opportunity to consider currently used drugs, such as statins, that are known to target the pathways leading to adhesion formation. Statins have been in use for decades and are among the most prescribed medications in the United States, with 26% of adults older than 40 years old taking a statin to lower cholesterol. By using robust epidemiological methods and large populationrepresentative data sets from 2 countries, the authors 4 found that concurrent statin use was associated with a decreased hazard of ARCs and SBOs in patients undergoing abdominal surgery in a dosedependent manner. The authors 4 used 2 large population data sets, The Health Improvement Network (THIN) from the United Kingdom and Optum Clinformatics Data Mart (Optum) data set from the United States, to examine the association between preoperative st...

show abstract

Use of Statins in Adhesive Small Bowel Obstruction

Cited by 9 publications

References 42 publications

Secular trends in small-bowel obstruction and adhesiolysis in the United States: 1988–2007

Secular trends in small-bowel obstruction and adhesiolysis in the United States: 1988–2007

Effect of statins on experimental postoperative adhesion: a systematic review and meta-analysis

Are Statins Associated With Reduced Risk of Adhesion-Related Complications After Abdominal Surgery?

Contact Info

Product

Resources

About