Abstract and Introduction
Background: Increased life expectancy and improved medical technology allow increasing numbers of elderly patients to undergo cardiac surgery. Elderly patients may be at greater risk of postoperative morbidity and mortality. Complications can lead to worsened quality of life, shortened life expectancy and higher healthcare costs. Reducing perioperative complications, especially severe adverse events, is key to improving outcomes in patients undergoing cardiac surgery. The objective of this study is to determine whether perioperative lipid-lowering medication use is associated with a reduced risk of complications and mortality after coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).
Methods: After IRB approval, we reviewed charts of 9,518 patients who underwent cardiac surgery with CPB at three medical centers between July 2001 and June 2015. The relationship between perioperative lipid-lowering treatment and postoperative outcome was investigated. 3,988 patients who underwent CABG met inclusion criteria and were analyzed. Patients were divided into lipid-lowering or non-lipid-lowering treatment groups.
Results: A total of 3,988 patients were included in the final analysis. Compared to the patients without lipid-lowering medications, the patients with lipid-lowering medications had lower postoperative neurologic complications and overall mortality (P < 0.05). Propensity weighted risk-adjustment showed that lipid-lowering medication reduced in-hospital total complications (odds ratio (OR) = 0.856; 95% CI 0.781–0.938; P < 0.001); all neurologic complications (OR = 0.572; 95% CI 0.441–0.739; P < 0.001) including stroke (OR = 0.481; 95% CI 0.349–0.654; P < 0.001); in-hospital mortality (OR = 0.616; 95% CI 0.432–0.869; P = 0.006; P < 0.001); and overall mortality (OR = 0.723; 95% CI 0.634–0.824; P < 0.001). In addition, the results indicated postoperative lipid-lowering medication use was associated with improved long-term survival in this patient population.
Conclusions: Perioperative lipid-lowering medication use was associated with significantly reduced postoperative adverse events and improved overall outcome in elderly patients undergoing CABG surgery with CPB.
With increased life expectancy and improved medical technology, more elderly patients are receiving cardiac surgery that undoubtedly carries an increased risk of postoperative morbidity and mortality. It has been shown that the overall complication rate of cardiac surgery may be as high as 66%.[1,2] These complications can lead to decreased quality of life, shortened life expectancy and higher healthcare costs. Reducing perioperative complications, especially severe adverse events, is key to improving outcomes in patients undergoing cardiac surgery.
Statins are inhibitors of the enzyme 3-hydroxy-3-methylglutaryl-coenzyme A reductase and are one of the most important lipid-lowering medicines. Their use is well established in treating hyperlipidemia by lowering plasma low-density lipid cholesterol (LDL-C) level. Apart from their lipid-lowering ability, the pleiotropic effect of statins has received more attention in recent years. The pleiotropic effect is associated with the improvement of endothelial function, reduction of vascular inflammation, stabilization of atherosclerotic plaques, inhibition of oxidative stress and prevention of vascular remodelling.[4–7] Because of these benefits, statins have been widely used for patients who suffer from cardiovascular diseases and undergo cardiac surgery. Studies have shown that perioperative statin therapy is associated with reductions of atrial fibrillation (AF), myocardial infarction (MI), vascular thrombosis, acute kidney injury (AKI), and infection after cardiac surgery.[8–13] Statin use has also been shown to reduce mortality and shorten the length of hospital stay (LOS) in the same patient population.[14–16] It has been suggested that surgical patients should resume statin therapy in the perioperative period, particularly patients with atherosclerotic cardiovascular disease. The goal of this study was to evaluate the effects of perioperative lipid-lowering medications on the incidence of postoperative adverse events and improving both short- and long-term outcomes in patients undergoing CABG/CABG with other procedures.
BMC Anesthesiol. 2022;22(122) © 2022 BioMed Central, Ltd.