ClinicalAtrial fibrillationStatin Use And Postoperative Atrial Fibrillation After Major Noncardiac Surgery
Introduction
Atrial fibrillation affects approximately 2.5 million people in the United States and roughly 10% of people older than 80 years.1 The chronic form of this disease has been recognized as an epidemic and a major contributor to rising health-care costs. Recently, postoperative atrial fibrillation (POAF) after coronary artery bypass graft surgery has been associated with increased morbidity and health-care cost,2, 3 highlighting the need for strategies to minimize its occurrence.
Anti-inflammatory medications such as corticosteroids and ketorolac have been shown to decrease the incidence of POAF,4, 5 which is not unexpected, since the connection between surgery and atrial fibrillation is thought to be predominantly mediated by systemic inflammation.6, 7, 8 Unfortunately, these agents retard wound healing and increase bleeding complications. Statin medications have also been shown to decrease POAF (in the setting of cardiac surgery)9; the putative mechanism is thought to be related to the “pleiotropic” anti-inflammatory properties of statins, as well as their direct antiarrhythmic effect on pulmonary vein tissue.10
Statins are associated with reduced mortality following noncardiac surgery.11, 12 The specific mechanisms by which statins may lower mortality in this group of patients have not been fully elucidated. A decrease in the incidence of myocardial ischemia has been implicated, but a lower incidence of postoperative arrhythmia in those receiving perioperative statin therapy may be another mediator for this protective effect. Few studies, none large, have examined the relationship between statins and POAF following noncardiac surgery.13 For that reason, we carried out a study to examine the association between statin use and the incidence of POAF in a large cohort of patients undergoing major noncardiac surgery in a broad selection of hospitals in the United States.
Section snippets
Sites And Subjects
Data collected from patients hospitalized for noncardiac surgery at 375 US hospitals were utilized. These data were obtained from Perspective, a database developed for quality and utilization benchmarking by Premier Incorporated, Charlotte, NC. In addition to data elements available in the standard hospital discharge file, the Perspective database contains a date-stamped log at the individual patient level of all billed items, including medications as well as laboratory, diagnostic, and
Patient Characteristics
A total of 370,447 patients meeting eligibility criteria underwent major noncardiac surgery during the study period and were included in the analysis. Of these, 79,871 patients (21.6%) received a statin medication in the perioperative period (Table 1, Table 2). Patients treated with statin medications were older and were more often white. Statin-treated patients were more likely to have been admitted electively and to list Medicare/Medicaid as their primary form of insurance. Prevalence of
Discussion
In this large cohort of noncardiac surgical patients, the administration of statin medications in the perioperative time period was associated with markedly reduced odds of developing clinically significant POAF. Although the absolute observed effect size was small (a 0.4% reduction in POAF), the at-risk pool of patients undergoing major noncardiac surgery is very large. This modest risk reduction could drive relevant changes in health-care cost and outcomes when applied to millions of patients
Conclusion
Results from our large national observational study suggest that statin use is associated with significantly lower risk for atrial fibrillation following major noncardiac surgery and that this association is robust across a wide range of surgical procedures and patient groups. Statin use did not improve outcomes for patients in whom clinically significant POAF occurred, suggesting that statins' effect is in primary prevention of adverse events. While our data should not be used as support for
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Cited by (11)
Perioperative Statin Use May Reduce Postoperative Arrhythmia Rates After Total Joint Arthroplasty
2021, Journal of ArthroplastyCitation Excerpt :The positive outcomes in the cardiac literature lead to the investigation of the potential effect of statins on arrhythmia development after various noncardiac surgeries. In a retrospective review of 370,447 patients, Bhave et al [31] found statin use in non-cardiac surgeries to be associated with a significantly lower postoperative atrial fibrillation rate (2.6%) compared to those patients who were not taking statins (3.0%). Oesterle et al [38] recently performed a meta-analysis reviewing different prophylactic agents against postoperative atrial fibrillation in noncardiac surgeries.
Surgical Comanagement by Hospitalists in Colorectal Surgery
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2018, American Journal of MedicineExpanding the role of statins in postoperative atrial fibrillation
2012, Heart RhythmPreoperative Statin Use Not Associated With Improved Outcomes After Ascending Aortic Repair
2018, Seminars in Thoracic and Cardiovascular SurgeryCitation Excerpt :Given the similar mechanism of formation in TAA, statins could benefit the natural history of TAA, in addition to short-term patient outcomes after repair. Multiple retrospective analyses have examined the impact of preoperative statin therapy on outcomes after noncardiac and vascular surgery.9–11 Purported benefits include reduction of atrial fibrillation, acute kidney injury (AKI), and death.
Exploring postoperative atrial fibrillation after non-cardiac surgery: mechanisms, risk factors, and prevention strategies
2023, Frontiers in Cardiovascular Medicine
Dr Auerbach and Ms Maselli were supported by a midcareer development grant from NHLBI (grant number K24HL098372) during this research. Dr Goldman was supported by an AHRQ K08 Mentored Clinical Scientist Development Award (grant number 1 K08 HS018090-01) and NIH/NCRR UCSF-CTSI grant (grant number UL1 RR024131).