Pre-EVAR Statin Therapy Shown to Improve Outcomes

April 12, 2010—In a study published online ahead of print in the Journal of Vascular Surgery, Michael N. McNally, MD, et al have concluded that preoperative statin therapy is associated with improved outcomes and resource utilization in patients undergoing elective abdominal aortic aneurysm (AAA) repair.

According to the investigators, the study hypothesized that preoperative statin therapy would have a protective effect on patients undergoing elective AAA repair and that the risk-reduction effect of these agents would result in a reduction in subsequent total hospital costs. All patients who underwent an elective endovascular AAA repair (EVAR) or open AAA repair (OAR) between 2004 and 2007 were retrospectively reviewed.

Clinical endpoints included number of 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 endpoint was the total hospital cost associated with the procedure.

The investigators identified 401 patients, consisting of 173 EVAR patients (43%) and 228 OAR patients (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% 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 to a lower total cost per patient of $3,205 for EVAR and $3,792 for OAR (P < .05). These data suggest that preoperative statin therapy should be an integral part of the risk optimization for patients undergoing AAA repair, the investigators stated.