Cardiovascular complications following major noncardiac surgery are
an important source of perioperative morbidity and mortality. Although lipid-lowering
medications are considered a key component in the primary and secondary prevention
of cardiovascular disease, their potential benefit during the perioperative
period is uncertain.
To examine the association between treatment with lipid-lowering medications
and in-hospital mortality following major noncardiac surgery.
Design, Setting, and Patients
A retrospective cohort study based on hospital discharge and pharmacy
records of 780 591 patients aged 18 years or older who underwent major
noncardiac surgery from January 1, 2000, to December 31, 2001, at any 1 of
329 hospitals throughout the United States. Only patients who survived through
at least the second hospital day were included. Lipid-lowering therapy was
defined as use during the first 2 hospital days. Propensity matching was used
to adjust for numerous baseline differences.
Main Outcome Measure
Of the 780 591 patients, 77 082 patients (9.9%) received lipid-lowering
therapy perioperatively and 23 100 (2.96%) died during the hospitalization.
Treatment with lipid-lowering agents was associated with lower crude mortality
(2.13% vs 3.05%, P<.001). In an analysis using
matching by propensity score, 1595 patients (2.18%) treated with lipid-lowering
medications died compared with 4158 patients (3.15%) who did not receive therapy
or in whom treatment was initiated after the second day (P<.001). After adjusting for residual differences in the propensity
matched groups using conditional logistic regression, risk of mortality remained
lower among treated patients (adjusted odds ratio [OR], 0.62; 95% confidence
interval [CI], 0.58-0.67). Based on this adjusted OR, the number needed to
treat to prevent a postoperative death in the propensity matched cohort was
85 (95% CI, 77-98) and varied from 186 among patients at lowest risk to 30
among those with a revised cardiac risk index score of 4 or more. In a further
analysis using the entire study cohort and adjusting for quintile of propensity,
a significant effect of treatment persisted (adjusted OR, 0.71; 95% CI, 0.67-0.75).
Treatment with lipid-lowering agents may reduce risk of death following
major noncardiac surgery. Clinical trials are required to confirm this observation.