Statin Drugs Lower Costs and Complications of Aortic Surgery
By Kathleen Louden
Medscape Medical News
October 20, 2009 (Chicago, Illinois) — Statin therapy administered before elective surgery to repair abdominal aortic aneurysm appears to decrease the morbidity, mortality, and cost of the procedure, regardless of whether the repair is open or endovascular, a new study shows.
The findings add to the evidence supporting the 2007 American Heart Association/American College of Cardiology (AHA/ACC) Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery (Circulation. 2007;116:1971-1996). These guidelines state that perioperative statin use is reasonable for patients undergoing vascular surgery and should be continued if the patient is already taking a statin.
"Statin therapy is the cornerstone of risk reduction in patients undergoing vascular surgery, especially aortic surgery," said the lead author Michael McNally, MD, a third-year general surgery resident at the East Carolina Heart Institute at East Carolina University in Greenville, North Carolina. "Statins are definitely not just cholesterol-lowering agents," he asserted.
Impact of Risk Optimization
Dr. McNally presented the results here at the American College of Surgeons 95th Annual Clinical Congress. The aim of the study was to determine the clinical and economic impact of cardiovascular risk optimization in patients undergoing repair of an aortic aneurysm.
A total of 181 patients who had elective aneurysm repair between 2004 and 2007 received statin medications preoperatively and 216 did not (control group), according to the abstract.
The statin cohort had a higher Society for Vascular Surgery (SVS) comorbidity risk score before surgery, indicating they were sicker, Dr. McNally said. However, these patients experienced significantly fewer postoperative complications than the control subjects (11.1% vs 4.4%, respectively; P?= .01). Complications measured included myocardial infarction, stroke, renal failure, bleeding, pneumonia, urinary tract infection, and wound infection.
No patients in the statin cohort died in the first 30?days after surgery, but 5% of control subjects did (a significant difference; P?< .01), the authors write in their abstract. Statin therapy translated to a hospital cost savings per patient of $3205 for endovascular repair and $3793 for open repair.
Dr. McNally reported in a press release that his team observed the significant benefit of statin therapy after only 30?days of treatment.
Results Changed Clinical Practice
"This [study result] has actually changed the practice pattern at our hospital," Dr. McNally said. He explained that the surgeons will prescribe a statin for referral patients who are not already receiving the medication, postpone the aneurysm repair, and inform the referring physician.
He told Medscape General Surgery that surgeons should evaluate whether they are adhering to the AHA/ACC guidelines and initiate appropriate therapy if they are not.
However, Philip Goodney, MD, a vascular surgeon at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, told Medscape General Surgery that, "given the observational, nonrandomized nature of this report, it is difficult to conclude from the data at hand that statin therapy should be mandated for primary prevention of cardiovascular complications in patients undergoing vascular surgery."
Dr. Goodney was the discussant for this presentation but did not participate in the study. "I think that the current study reinforces larger series and trials that have confirmed the overall benefits of statin therapy in a broad range of vascular procedures," he said during the interview.
Dr. McNally and Dr. Goodney have disclosed no relevant financial relationships.
American College of Surgeons (ACS) 95th Annual Clinical Congress: Surgical Forum. Presented October 15, 2009.
