title: Association of Perioperative Statin Use With Mortality and Morbidity After Major Noncardiac Surgery.
abstract: The efficacy of statins in reducing perioperative cardiovascular and other organ system complications in patients undergoing noncardiac surgery remains controversial. Owing to a paucity of randomized clinical trials, analyses of large databases may facilitate informed hypothesis generation and more efficient trial design.
  
  
  
  To evaluate associations of early perioperative statin use with outcomes in a national cohort of veterans undergoing noncardiac surgery.
  
  
  
  This retrospective, observational cohort analysis included 180 478 veterans undergoing elective or emergent noncardiac surgery (including vascular, general, neurosurgery, orthopedic, thoracic, urologic, and otolaryngologic) who were admitted within 7 days of surgery and sampled by the Veterans Affairs Surgical Quality Improvement Program (VASQIP). Patients were admitted to Department of Veterans Affairs hospitals and underwent 30-day postoperative follow-up. Data were collected from October 1, 2005, to September 30, 2010, and analyzed from November 28, 2013, to October 31, 2016.
  
  
  
  Statin use on the day of or the day after surgery.
  
  
  
  All-cause 30-day mortality (primary outcome) and standardized 30-day cardiovascular and noncardiovascular outcomes captured by VASQIP. Use of statins and other perioperative cardiovascular medications was ascertained from the Veterans Affairs Pharmacy Benefits Management research database.
  
  
  
  A total of 180 478 eligible patients (95.6% men and 4.4% women; mean [SD] age, 63.8 [11.6] years) underwent analysis, and 96 486 were included in the propensity score-matched cohort (96.3% men; 3.7% women; mean [SD] age, 65.9 [10.6] years). At the time of hospital admission, 37.8% of patients had an active outpatient prescription for a statin, of whom 80.8% were prescribed simvastatin and 59.5% used moderate-intensity dosing. Exposure to a statin on the day of or the day after surgery based on an inpatient prescription was noted in 31.5% of the cohort. Among 48 243 propensity score-matched pairs of early perioperative statin-exposed and nonexposed patients, 30-day all-cause mortality was significantly reduced in exposed patients (relative risk, 0.82; 95% CI, 0.75-0.89; P < .001; number needed to treat, 244; 95% CI, 170-432). Of the secondary outcomes, a significant association with reduced risk of any complication was noted (relative risk, 0.82; 95% CI, 0.79-0.86; P < .001; number needed to treat, 67; 95% CI, 55-87); all were significant except for the central nervous system and thrombosis categories, with the greatest risk reduction (relative risk, 0.73; 95% CI, 0.64-0.83) for cardiac complications.
  
  
  
  Early perioperative exposure to a statin was associated with a significant reduction in all-cause perioperative mortality and several cardiovascular and noncardiovascular complications. However, the potential for selection biases in these results must be considered.
authors.affiliation: Department of Anesthesia and Perioperative Care, University of California, San Francisco2Department of Anesthesia and Perioperative Care, Department of Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: London
authors.affiliation: Cardiology Section, Department of Medicine, Department of Veterans Affairs Medical Center, Denver, Colorado.
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Schwartz
authors.affiliation: Center for Medication Safety, Pharmacy Benefits Management Services, Department of Veterans Affairs Medical Center, Hines, Illinois.
authors.forename: Kwan
authors.initials: K
authors.lastname: Hur
authors.affiliation: Department of Biostatistics, University of Colorado, Denver6Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS) and Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora.
authors.forename: William G
authors.initials: WG
authors.lastname: Henderson
mesh_terms: D000368:Aged; D002423:Cause of Death; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D009017:Morbidity / Q000639:trends; D009026:Mortality / Q000639:trends*; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015983:Selection Bias; D013514:Surgical Procedures, Operative; D014728:Veterans
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors