Background:
Starting from early to mid 2000s a growing body of literature has been produced on the potential role of statins in reducing perioperative cardiac events in patients undergoing non-cardiac surgery. However, evidence remains inconsistent and little is known regarding the use of perioperative statins in clinical practice.
Objectives:
To examine pattern of statin initiation among patients undergoing non-cardiac elective surgery in the US.
Methods:
Using data from a large US healthcare insurer, we identified patients ≥18 years who underwent moderate- to high-risk non-cardiac elective surgery and initiated statins within 30-days before surgery. We assessed trends of statin initiation over time and predictors of initiation. To ensure statin initiation was precipitated by non-cardiac surgery vs. alternative indications, we also assessed the effect of temporal proximity to surgery on initiation in a matched analysis.
Results:
Of 460,154 patients undergoing surgery between 2003-2012, 5,628 (1.2%) initiated a statin before surgery. Initiation rate increased from 0.8% in 2003 to 1.5% in 2012 (p = .0004). The increase was more pronounced among patients with revised cardiac risk index (RCRI) score ≥2 and patients undergoing vascular surgery, with initiation rates equal to 7.2% and 14.9% respectively by the end of 2012. Proximity to surgery was predictive of statin initiation (p < .0001). Significant predictors of initiation were older age, male sex, revised cardiac risk index (RCRI) score ≥1, vascular or orthopedic surgery. At the most recent estimate, patients undergoing vascular surgery and with a RCRI score ≥2 had initiation rates equal to 19.9%.
Conclusions:
The rate of statin initiation progressively increased from 2003 to 2012, particularly among patients with higher RCRI score and undergoing major vascular surgery. Research is needed to further define the risks and benefits of initiation of statins prior to surgery.
The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) predicts cardiac complications more accurately than the Revised Cardiac Risk Index in vascular surgery patients