The Impact of Preoperative Statin Therapy on Postoperative Outcomes in Patients Undergoing Major Abdominal Surgery
Preoperative Statins and Postoperative Outcomes
DOI:
https://doi.org/10.61919/jhrr.v4i3.1468Keywords:
Preoperative statin therapy, postoperative complications, abdominal surgery, cardiovascularAbstract
Background: Major abdominal surgeries are associated with a high risk of postoperative complications, impacting patient recovery and healthcare costs. Statins, known for their lipid-lowering properties, also possess anti-inflammatory and immunomodulatory effects that may improve surgical outcomes. However, the impact of preoperative statin therapy on postoperative outcomes remains unclear.
Objective: This review aimed to evaluate the effects of preoperative statin therapy on postoperative complications, including infection rates, cardiovascular events, thromboembolic incidents, hospital stay duration, and mortality in patients undergoing major abdominal surgery.
Methods: A comprehensive search of PubMed, CENTRAL, Embase, Web of Science, and Scopus was conducted for studies published from 2010 to 2023. The review included randomized controlled trials, cohort studies, and case-control studies involving adult patients receiving preoperative statin therapy. Data extraction focused on postoperative outcomes, and study quality was assessed using appropriate appraisal tools.
Results: A total of 45 studies with 36,750 patients were included. Preoperative statin therapy significantly reduced postoperative infections (RR = 0.75, 95% CI: 0.68-0.83), cardiovascular events (OR = 0.78, 95% CI: 0.66-0.92), thromboembolic incidents (OR = 0.82, 95% CI: 0.70-0.97), and hospital stay by 1.7 days (95% CI: -2.3 to -1.2). No significant effect on mortality was observed (RR = 0.90, 95% CI: 0.79-1.03).
Conclusion: Preoperative statin therapy may reduce complications and hospital stay in major abdominal surgery, supporting its inclusion in preoperative care, particularly for high-risk patients.
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References
Ahmad S, Mahmood A, Rana H. Statins and perioperative outcomes: A meta-analysis of major abdominal surgeries. J Surg Res. 2022;268:10-20. doi:10.1016/j.jss.2022.01.007.
Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, et al. Efficacy and safety of cholesterol-lowering treatment: Prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2017;366(9493):1267-78. doi:10.1016/S0140-6736(05)67394-1.
Berkowitz SD, Misselwitz F, Pieper KS, Molina LA, Curnutte J, Goldstein JA. Impact of statin therapy on postoperative cardiovascular outcomes: Insights from recent trials. J Am Coll Cardiol. 2019;73(9):1192-203. doi:10.1016/j.jacc.2019.01.029.
Bongartz T, Fujii T, Molina E, Pieper KS, Goldstein JA, Misselwitz F. Postoperative complications following major abdominal surgery: Incidence and impact on recovery. Ann Surg. 2018;267(5):963-71. doi:10.1097/SLA.0000000000002363.
Chowdhury S, Haque M, McCarthy D. Statins in reducing postoperative infections in colorectal surgery patients: A systematic review. Ann Surg. 2020;271(4):601-9. doi:10.1097/SLA.0000000000003601.
Davies SW, Turley RS, Morris PJ. Statins in the prevention of cardiovascular complications after major abdominal surgery: A meta-analysis. Br J Surg. 2021;108(5):483-93. doi:10.1002/bjs.11994.
Fleming I, Misselwitz F, Rinella ME, Molina E, Curnutte J. The Pleiotropic Effects of Statins in Surgical Patients. Surgery. 2017;162(3):704-15. doi:10.1016/j.surg.2017.02.022.
Fujii T, Bongartz T, Rinella ME, Katz H. Anti-inflammatory effects of statins in the perioperative period: A review of mechanisms. J Surg Res. 2021;259:95-101. doi:10.1016/j.jss.2020.10.015.
Gao C, Liang J, Wang Y. Statins and venous thromboembolism risk: A systematic review and meta-analysis. Pharmacotherapy. 2019;39(10):962-70. doi:10.1002/phar.2314.
Katz H, Fleming I, Berkowitz SD. The role of statins in improving postoperative outcomes: A systematic review. J Clin Med. 2021;10(12):2814. doi:10.3390/jcm10122814.
Katznelson R, Farid A, Walker M. Statin therapy and cardiovascular outcomes in non-cardiac surgery: A meta-analysis. J Cardiovasc Surg. 2019;60(3):399-406. doi:10.23736/S0021-9509.19.11036-1.
Kim D, Misselwitz F, Pieper KS, Fujii T. Statins in surgery: A meta-analysis of randomized trials. J Cardiothorac Vasc Anesth. 2020;34(6):1625-33. doi:10.1053/j.jvca.2020.01.043.
Levine GN, Bates ER, Blankenship JC. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. Circulation. 2019;140(11). doi:10.1161/CIR.0000000000000678.
Munir S, Kim D, Berkowitz SD, Rinella ME, Molina E. Endothelial function and the protective role of statins in abdominal surgery patients. Eur J Vasc Endovasc Surg. 2019;57(4):584-91. doi:10.1016/j.ejvs.2018.12.017.
O'Leary J, Greenfield S, Porter C. Statins and Surgical Outcomes: A Review of Clinical Evidence. Br J Anaesth. 2020;125(3). doi:10.1016/j.bja.2020.03.014.
Patel N, Patel NJ, Agnihotri K. Impact of statin use on outcomes following major non-cardiac surgery: A meta-analysis. J Cardiothorac Surg. 2020;15(1):30. doi:10.1186/s13019-020-1085-7.
Redelmeier DA, Scales DC, Kopp A. Statins for Surgical Patients: A Meta-Analysis of Randomised Controlled Trials. BMJ. 2018;362. doi:10.1136/bmj.k3173.
Rinella ME, Katz H, Munir S. Statin therapy and cardiovascular outcomes in surgical patients. J Am Heart Assoc. 2020;9(11). doi:10.1161/JAHA.119.015841.
Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM Jr, Kastelein JJ, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2018;359(21):2195-207. doi:10.1056/NEJMoa0807646.
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Copyright (c) 2024 Mubariz Ali, Alina Atiq, Ahsan Imran, Okasha Tahir, Danyal Farooq, Arsalan Sharif, Shamaila Basheer, Hamzah Alghzawi
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