How Retail Clinicians Can Help Prevent Postsurgical Complications

Although postsurgical complications are often a major concern for patients planning to undergo a procedure, retail clinicians are ideally placed to provide counseling on ways to prevent them.

In particular, retail clinicians can recommend statins to patients planning to undergo coronary artery bypass grafting (CABG) in order to help reduce their risk for cardiac complications.

A new study published in theAnnals of Thoracic Surgerysought to evaluate statins’ effects on patient outcomes by examining the drug’s use before and after CABG among patients who underwent the procedure.

The research team found that the use of statins both prior to and following CABG was associated with a reduction in cardiac complications such as atrial fibrillation after the procedure. Statin use was also linked to a reduced risk of death during and immediately after CABG.

The study authors explained that the body frequently responds to procedures such as CABG with an intense inflammatory reaction that can lead to postoperative complications. Although statins are generally used to lower cholesterol, they also have anti-inflammatory properties that may prevent these complications by reducing inflammation.

“The results of our review call for proactive efforts to counsel patients and surgeons about the benefit of statins—a benefit that definitely outweighs the risk of rare potential side effects,” said study author Amr F. Barakat, MD, in a press release.

The authors noted that further research is needed to establish an optimal statin dose and duration, as well as to determine the potential benefits of statins in reducing the risk of stroke, heart attack, or kidney problems after surgery.

Statins are not the only medications that offer preventative benefits to patients undergoing surgery. Clinicians can also encourage patients who are already taking high blood pressure medications to resume their treatment within 48 hour of surgery.

A separatestudyrecently examined data from more than 30,000 patients who underwent non-cardiac surgery between 1999 and 2011. While the patients were all regularly taking angiotensin II receptor blockers (ARBs) for the treatment of hypertension prior to surgery, nearly one-third of them did not resume the therapy within 2 days of the procedure.

The research team found that resuming ARBs within 48 hours of the procedure was associated with a 50% lower mortality rate in the first 30 days after surgery, as well as decreased rates of infection, pneumonia, heart failure, and kidney failure.

The study authors suggested that many patients do not resume ARBs after surgery because of poorly coordinated care transitions between different hospital units, as well as concerns from providers that the antihypertensives could cause dangerously low blood pressure or disrupt kidney function.

“Sometimes, doctors briefly stop ARB medications around the time of surgery because they are known to cause low blood pressure while under general anesthesia, which can be dangerous for the patient,” said lead study author Susan Lee, MD, in a press release. “Our study highlights the importance of resuming medications that patients were previously taking at home as soon as it is feasible after surgery.”

The study results were published inAnesthesiology.