Richman JS, Graham LA, DeRussy A et al.
The American Journal of Surgery 2017; 214 (2): 180-185
Recent publications report that perioperative initiation of statin therapy is associated with improved outcomes, particularly among patients with increased cardiac risk. However, findings on associations with beta blocker (BB) initiation are mixed. This study examined associations between perioperative statin and BB use in a national sample of patients with cardiac stents.
This retrospective cohort study was conducted across Veterans Association Medical Centers across the USA. It included all patients undergoing non-cardiac surgery within two years after stent placement, between October 2002 and September 2011, with BB and/or statin prescriptions within one year prior to surgery.
Using VA inpatient data it identified major adverse cardiac or cerebrovascular events (MACCE) within 30 days of surgery. General usage patterns and percent of days covered by medication were calculated as additional markers of medication use. Adjusted logistic regression was used to examine associations between medication use and 30-day postoperative outcomes.
23,537 patients underwent surgery within 2 years following stent placement, of whom 20,566 (88.6%) had prescriptions for beta blockers and statins within 365 days prior to surgery. Of those, 13,501 (65.6%) used both BB and statins prior to surgery, while 2626 (12.8%) used only BB, 2346 (11.4%) used only statins, and 2093 (10.2%) used neither. In fully adjusted models, the only significant association was between perioperative statin use and decreased mortality (OR 0.65, 95% CI 0.48-0.87). This association was stronger for patients with higher cardiac risk index.
The results suggest that maintaining statin therapy perioperatively is associated with reduced 30 day mortality in stented patients undergoing non-cardiac surgery who have previously been prescribed both beta blockers and statins.
Journal Club Discussion
Discussion focused on
- Whether logistics regression will ever produce equally or superiorly comparable cohorts for comparison of an intervention compared to a RCT, given significantly larger potential study sample sizes.
- Whether drug intervention trials for drugs taken in the commIn unity should allow patients to be on a ‘free” dose titrated for them to family practitioners, rather than a one-size fits all dose that may be a sub-maximal or over-dose for their size and pharmacogenetics profile .
Summary by Dr A. Beverly. Journal Club 16 November 2017.