title: Statin withdrawal after major noncardiac surgery: risks, consequences, and preventative strategies.
abstract: BACKGROUND
  A growing body of research suggests that statins improve perioperative cardiac outcomes by attenuating inflammation. Conversely, some studies suggest that withdrawal of statins after surgery results in an upsurge of inflammation and adverse cardiac outcomes.
  
  
  METHODS
  We performed a literature search using multiple medical databases to examine the basic, clinical, and experimental evidence supporting the existence of a statin withdrawal state. Studies examining outcomes associated with statin withdrawal were narratively synthesized.
  
  
  RESULTS
  Published evidence suggests that statin withdrawal is associated with worse cardiac outcomes in a variety of scenarios, including acute coronary syndrome, ischemic stroke, and surgery. Although certain reasons for postoperative statin cessation are difficult to avoid (eg, ileus after surgery), we posit that many perioperative clinicians may be unaware of the importance of statin resumption in a timely fashion. This lack of awareness translates into preventable harm and an opportunity for outcome improvement. We introduce innovative practices through which perioperative practitioners may prevent statin discontinuation.
  
  
  CONCLUSIONS
  Ensuring the resumption of statins after surgery should become routine practice for perioperative providers. We highlight knowledge gaps and identify a research agenda aimed at better understanding this practice.
authors: Department of General Internal Medicine, University of Michigan Health System, Ann Arbor, MI 48109, USA. nabilf@umich.edu
authors: Nabil
authors: N
authors: Fallouh
authors: Vineet
authors: V
authors: Chopra
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy; D002545:Brain Ischemia / Q000188:drug therapy; D016208:Databases, Factual; D013502:General Surgery; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D007249:Inflammation / Q000209:etiology / Q000517:prevention & control; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology*; D018570:Risk Assessment / Q000379:methods; D016312:Treatment Refusal
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors