Anesthesia Service, Veterans Affairs Palo Alto Health Care System, Palo Alto and Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, California.
J Hosp Med. 2014 May;9(5):289-96. doi: 10.1002/jhm.2182.
Angiotensin-converting enzyme inhibitors (ACE-Is) are a widely used class of cardiovascular medication. However, limited data exist on the risks of postoperative nonresumption of an ACE-I.
To evaluate the factors and 30-day mortality risks associated with the postoperative nonresumption of an ACE-I.
A retrospective cohort study.
Veterans Affairs (VA) Healthcare System.
A total of 294,505 admissions in 240,978 patients with multiple preoperative prescription refills (>3) for an ACE-I who underwent inpatient surgery from calendar years 1999 to 2012.
None.
We classified surgical admissions based upon the timing of postoperative resumption of an ACE-I prescription from the day of surgery through postoperative days 0 to 14 and 15 to 30, and collected 30-day mortality data. We evaluated the relationship between 30-day mortality and the nonresumption of an ACE-I from postoperative day 0 to 14 using proportional hazard regression models, adjusting for patient- and hospital-level risk factors. Sensitivity analyses were conducted using more homogeneous subpopulations and propensity score models.
Twenty-five percent of our cohort did not resume an ACE-I during the 14 days following surgery. Nonresumption of an ACE-I within postoperative day 0 to 14 was independently associated with increased 30-day mortality (hazard ratio: 3.44; 95% confidence interval: 3.30-3.60; P < 0.001) compared to the restart group. Sensitivity analyses maintained this relationship.
Nonresumption of an ACE-I is common after major inpatient surgery in the large VA Health Care System. Restarting of an ACE-I within postoperative day 0 to 14 is, however, associated with decreased 30-day mortality. Careful attention to the issue of timely reinstitution of chronic medications such as an ACE-I is indicated.
血管紧张素转换酶抑制剂（ACE-Is）是一类广泛使用的心血管药物。然而，关于术后不继续使用 ACE-I 的风险的数据有限。
评估与术后不继续使用 ACE-I 相关的因素和 30 天死亡率风险。
回顾性队列研究。
退伍军人事务部（VA）医疗保健系统。
1999 年至 2012 年期间，共有 240978 名患者在 294505 次住院期间接受了多次术前处方（>3 次）ACE-I 药物治疗，进行了住院手术。
无。
我们根据术后 ACE-I 处方恢复的时间，将手术入院分为从手术日起至术后第 0 至 14 天和第 15 至 30 天，并收集了 30 天死亡率数据。我们使用比例风险回归模型评估了术后第 0 至 14 天不继续使用 ACE-I 与 30 天死亡率之间的关系，调整了患者和医院水平的风险因素。使用更同质的亚人群和倾向评分模型进行了敏感性分析。
我们队列的 25%在术后 14 天内没有继续使用 ACE-I。与重新开始组相比，术后第 0 至 14 天内不继续使用 ACE-I 与 30 天死亡率增加独立相关（危险比：3.44；95%置信区间：3.30-3.60；P<0.001）。敏感性分析维持了这种关系。
在大型退伍军人事务部医疗保健系统中，大型住院手术后不继续使用 ACE-I 很常见。然而，在术后第 0 至 14 天内重新开始使用 ACE-I 与 30 天死亡率降低相关。需要谨慎关注 ACE-I 等慢性药物的及时重新使用问题。
