title: Effects of statins on ischemia-reperfusion complications in breast free flaps.
abstract: BACKGROUND
  Administration of statins or other cardiovascular medications (CVMs) could potentially protect against the development of ischemia-reperfusion (I/R) injury in free flap reconstruction. The aim of this study was to examine whether the use of statins and other CVMs decreased the rate of I/R injury in autologous free flap breast reconstruction.
  
  
  METHODS
  Retrospective chart review was performed on women who had undergone mastectomy and autologous free flap breast reconstruction between 2004 and 2010. Patient characteristics, use of statin and/or CVMs, and I/R-related complications were ascertained. Multivariable logistic regression was used to identify associations between independent risk factors and specific complications.
  
  
  RESULTS
  There were 702 free flap breast reconstructions included in this study; 45 performed in patients on statins, 70 in patients on CVMs, and 38 in patients on both. Overall complication rate in patients on statins and patients on CVMs was significantly higher than those not on any medication (46.7% versus 31.5%, P=0.037 and 45.7% versus 31.5%, P=0.017, respectively). When I/R complications were pooled, there were no significant differences between patients not on any medications and those on statins (P=0.26), CVMs (P=0.18), and both (P=0.83.)
  
  
  CONCLUSIONS
  Although there may be theoretical pharmacologic benefits of statins and/or CVMs to reduce the incidence of IR injury in autologous free flap breast reconstruction, the results of this study showed no clear advantages when these drugs were used.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Pieter G L
authors.initials: PG
authors.lastname: Koolen
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: John T
authors.initials: JT
authors.lastname: Nguyen
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ahmed M S
authors.initials: AM
authors.lastname: Ibrahim
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Oren
authors.initials: O
authors.lastname: Ganor
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Danielle J
authors.initials: DJ
authors.lastname: Chuang
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Lin
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: blee3@bidmc.harvard.edu.
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Lee
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology*; D016015:Logistic Models; D016462:Mammaplasty / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D015427:Reperfusion Injury / Q000517:prevention & control*; D012189:Retrospective Studies; D013524:Surgical Flaps
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Breast reconstruction; DIEP; Ischemia–reperfusion injury; Reconstructive surgery; Statins