Department of Anesthesiology, Peking University International Hospital, Beijing, China.
Department of Anesthesiology and Pain Medicine, University of California Davis Health, 4150 V Street, Suite 1200, Sacramento, CA, 95817, USA.
BMC Anesthesiol. 2022 Apr 26;22(1):122. doi: 10.1186/s12871-022-01675-9.
Increased life expectancy and improved medical technology allow increasing numbers of elderly patients to undergo cardiac surgery. Elderly patients may be at greater risk of postoperative morbidity and mortality. Complications can lead to worsened quality of life, shortened life expectancy and higher healthcare costs. Reducing perioperative complications, especially severe adverse events, is key to improving outcomes in patients undergoing cardiac surgery. The objective of this study is to determine whether perioperative lipid-lowering medication use is associated with a reduced risk of complications and mortality after coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).
After IRB approval, we reviewed charts of 9,518 patients who underwent cardiac surgery with CPB at three medical centers between July 2001 and June 2015. The relationship between perioperative lipid-lowering treatment and postoperative outcome was investigated. 3,988 patients who underwent CABG met inclusion criteria and were analyzed. Patients were divided into lipid-lowering or non-lipid-lowering treatment groups.
A total of 3,988 patients were included in the final analysis. Compared to the patients without lipid-lowering medications, the patients with lipid-lowering medications had lower postoperative neurologic complications and overall mortality (P < 0.05). Propensity weighted risk-adjustment showed that lipid-lowering medication reduced in-hospital total complications (odds ratio (OR) = 0.856; 95% CI 0.781-0.938; P < 0.001); all neurologic complications (OR = 0.572; 95% CI 0.441-0.739; P < 0.001) including stroke (OR = 0.481; 95% CI 0.349-0.654; P < 0.001); in-hospital mortality (OR = 0.616; 95% CI 0.432-0.869; P = 0.006; P < 0.001); and overall mortality (OR = 0.723; 95% CI 0.634-0.824; P < 0.001). In addition, the results indicated postoperative lipid-lowering medication use was associated with improved long-term survival in this patient population.
Perioperative lipid-lowering medication use was associated with significantly reduced postoperative adverse events and improved overall outcome in elderly patients undergoing CABG surgery with CPB.
预期寿命的延长和医疗技术的进步使得越来越多的老年患者能够接受心脏手术。老年患者术后发病率和死亡率的风险可能更高。并发症会导致生活质量恶化、预期寿命缩短和医疗保健费用增加。降低围手术期并发症，特别是严重不良事件，是改善心脏手术患者预后的关键。本研究旨在确定围手术期降脂药物的使用是否与体外循环（CPB）下冠状动脉旁路移植术（CABG）后并发症和死亡率的降低有关。
在获得机构审查委员会批准后，我们回顾了 2001 年 7 月至 2015 年 6 月期间在三个医疗中心接受 CPB 心脏手术的 9518 名患者的图表。研究了围手术期降脂治疗与术后结果之间的关系。共有 3988 名接受 CABG 的患者符合纳入标准并进行了分析。患者分为降脂或非降脂治疗组。
共有 3988 名患者纳入最终分析。与未接受降脂药物治疗的患者相比，接受降脂药物治疗的患者术后神经系统并发症和总死亡率较低（P < 0.05）。倾向评分风险调整显示，降脂药物治疗可降低住院期间总并发症（比值比（OR）= 0.856；95%置信区间 0.781-0.938；P < 0.001）；所有神经系统并发症（OR = 0.572；95%置信区间 0.441-0.739；P < 0.001），包括中风（OR = 0.481；95%置信区间 0.349-0.654；P < 0.001）；住院死亡率（OR = 0.616；95%置信区间 0.432-0.869；P = 0.006；P < 0.001）；以及总死亡率（OR = 0.723；95%置信区间 0.634-0.824；P < 0.001）。此外，结果表明，在该患者人群中，术后降脂药物的使用与长期生存的改善相关。
在接受 CPB 下 CABG 手术的老年患者中，围手术期降脂药物的使用与术后不良事件显著减少和整体预后改善相关。
