Perioperative vascular consequence...

Perioperative vascular consequences are common, particularly in patients undergoing vascular steps Although there are ways to identify high-risk patients, preventive measures are limited. Beta blocker therapy is individual pharmacologic method that has had moderate efficacy in reducing risk. Lipid-lowering agents have anti-inflammatory efficiencys and other plaque stabilizing properties. Lindenauer and colleagues studied whether lipid-lowering agents cut short mortality from myocardial infarction in patients undergoing major noncardiac surgery

The retrospective cohort reflection included noncardiac surgery patients 18 years or older The authors mustered data on surgery type, comorbidities, and concomitant medications. Patients were divided into brace groups--those who received lipid-lowering agents perioperatively (by day 3 of their hospital stay)and those who received the remedys late in their hospital stay or not at all. Patients in the treated dispose were further categorized as receiving statin or nonstatin therapy.

The analysis included 780 591 patients (77 082 in the treated group) About united fourth of treated patients had ischemic heart disease. Treated patients were likely to be white men have higher revised cardiac index scores, and have more comorbidities compared with untreated and late-treated patients. The treated assign places to also was more likely to have undergone orthopedic or vascular actions and received beta blocker therapy and thromboembolism prevention measures. After matching treated and untreated patients, the authors lay the foundation of that 1,595 (2.18 percent)of the treated patients died, compared with 4158 patients (315 percent)in the untreated and late-treated assign places tos The adjusted odds ratio for mortality favoring lipid-lowering agents was 062 and the number wanted to treat was 85, yet varied depending on cardiac risk. Statin and nonstatin users had a slightly lower mortality rate (209 versus 250 percent respectively) compared with untreated or late-treated patients.

The authors judge that patients undergoing major noncardiac surgery who are given lipid-lowering agents perioperatively have a 1 percent absolute reduction in mortality, representing a 38 percent decreased risk for in-hospital mortality compared with untreated or late-treated patients. The authors caution that lipid-lowering agents are not administered routinely early in a hospital stay. Therefore, lipid-lowering therapy in this reflection likely represents a resumption of ongoing outpatient therapy, and it is not known when lipid-lowering therapy should be initiated to achieve the weights noted in this study. This is an observational consideration and the authors suggest that perioperative lipid-lowering therapy may be a marker for other aspects of care that lower mortality risk in surgery patients.

Lindenauer PK et al. Lipid-lowering therapy and in-hospital mortality following major noncardiac surgery JAMA May 5 2004;291:2092-9

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