Preoperative statin therapy is associated with improved outcomes and resource utilization in patients undergoing aortic aneurysm repair

Introduction This study hypothesized that preoperative statin therapy would have a protective effect on patients undergoing elective abdominal aortic aneurysm (AAA) repair and that the risk-reduction effect of these agents would result in a reduction in subsequent total hospital costs. Methods All p...

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Published in:Journal of vascular surgery 2010-06, Vol.51 (6), p.1390-1396
Main Authors: McNally, Michael M., MD, Agle, Steven C., MD, Parker, Frank M., DO, Bogey, William M., MD, Powell, Charles S., MD, Stoner, Michael C., MD
Format: Article
Language:English
Subjects:
Aged
Aortic Aneurysm, Abdominal - economics
Aortic Aneurysm, Abdominal - mortality
Aortic Aneurysm, Abdominal - surgery
Biological and medical sciences
Blood and lymphatic vessels
Blood Vessel Prosthesis Implantation - adverse effects
Blood Vessel Prosthesis Implantation - economics
Blood Vessel Prosthesis Implantation - mortality
Cardiology. Vascular system
Chi-Square Distribution
Delivery of Health Care - economics
Delivery of Health Care - utilization
Diseases of the aorta
Drug Costs
Elective Surgical Procedures
Female
Hospital Costs
Hospital Mortality
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - economics
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Length of Stay
Logistic Models
Male
Medical sciences
Outcome and Process Assessment (Health Care) - economics
Retrospective Studies
Risk Assessment
Risk Factors
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Time Factors
Treatment Outcome
Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
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Summary:Introduction This study hypothesized that preoperative statin therapy would have a protective effect on patients undergoing elective abdominal aortic aneurysm (AAA) repair and that the risk-reduction effect of these agents would result in a reduction in subsequent total hospital costs. Methods All patients who underwent an elective endovascular AAA repair (EVAR) or open AAA repair (OAR) between 2004 and 2007 were retrospectively reviewed. Clinical end points included postoperative days, length of hospital stay, postoperative complications (myocardial infarction, stroke, renal failure, hemorrhage, pneumonia, urinary tract infection, wound infection), and 30-day mortality. The financial end point was total hospital cost associated with the procedure. Results We identified 401 patients, consisting of 173 EVAR patients (43%) and 228 OAR (57%). Despite a higher Society for Vascular Surgery risk score, the EVAR statin cohort had significantly reduced postoperative days (1.9 ± 0.2 vs 2.3 ± 0.3, P < .05) and hospital length of stay (2.3 ± 0.3 vs 2.8 ± 0.4, P < .05) compared with the nonstatin EVAR cohort. Postoperative complications (4.4% vs 14.7%, P < .05) and the mortality rate (0.0% vs 5.9%, P < .05) were significantly decreased in the OAR statin cohort compared with the nonstatin OAR cohort and trended to be decreased in the EVAR statin group. Statin therapy translated into a lower total cost per patient of $3,205 for EVAR and $3,792 for OAR ( P < .05). Conclusion With respect to both clinical outcome measures and subsequent resource utilization, statin therapy is associated with a beneficial effect in patients undergoing elective AAA repair. These data suggest that preoperative statin therapy should be an integral part of the risk optimization for patients undergoing AAA repair.
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2010.01.028