Date of Award

11-3-2009

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Ronnie Rosenthal, MD, MS

Second Advisor

Selwyn Rogers, MD, MPH

Abstract

Relationship Between Preoperative Statin Use And Postoperative Infectious Complications in General and Non-Cardiac Surgery Johnathan A. Bernard1,2, Ronnie A. Rosenthal1, Selwyn O. Rogers2 1: Department of Surgery, West Haven VA Medical Center, Yale University School of Medicine, New Haven, CT 2: Center for Surgery and Public Health, Harvard School of Public Health, Boston, MA Objective: Characterize the impact of preoperative statin use on postoperative infectious complications and 30-day postoperative mortality in general and non-cardiac surgery patients. Background: The lipid lowering effects of statins have been well documented for the treatment of coronary artery disease. There has been mounting evidence to support use of statins for their pleiotropic effect. Among these, immune system modulation, improved endothelial function, attenuation of sepsis, and organ protection are particularly relevant to the surgical patient. However, the pleiotropic effects of statins are poorly understood postoperatively in general and non-cardiac surgery patients. Design: Retrospective observational study conducted to test the hypothesis that preoperative statin use leads to a risk reduction of postoperative infectious complications (POIC) (any occurrence of surgical site infection, deep surgical site infection, wound dehiscence,pneumonia, urinary tract infection, sepsis, or septic shock) and would reduce the risk of 30 day postoperative mortality, while identifying independent risk factors for POIC. To do so, the ACS NSQIP database at a 777-bed academic medical center was merged with pharmacy data and electronic medical records at the same institution from January 1, 2006 to January 1, 2008. Results: Two thousand, five hundred and eighty four patients underwent major general and non-cardiac surgery during the study time period. Five hundred and seventy eight of these patients were on statin therapy before admission and continued statin therapy after surgery. A total of two hundred and twenty four POIC occurred. Best-fit logistic regression models demonstrated that ASA classification, length of operation, and emergent status of case were associated with an increase in POIC. Patients receiving statins, when adjusted for ASA classification, length of operation, and case emergency, did not have a reduced risk of POIC, with an AOR 0.978 (95% CI 0.58 1.63, p = 0.93). Statin use was, however, associated with a reduction in 30 day postoperative mortality (OR 0.45; 95% CI 0.23 0.87, p = 0.019). Conclusion: Preoperative statin therapy reduces the risk of 30 day mortality, but its effect on reducing POIC after general surgery remains to be proven. Further research is needed to evaluate the role of preoperative statin therapy and its pleiotropic effects in surgical patients.

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