USA: Statins and Postoperative Adhesion-Related Complications

Statins may be an inexpensive, well-tolerated pharmacologic option for the prevention of postoperative adhesion-related complications (ARCs) in people undergoing intra-abdominal surgery, finds a recent study in the journal JAMA Network Open.

The common complications of intra-abdominal surgery are adhesion-related complications (ARCs), including small-bowel obstruction. Statins, which have antifibrotic pleiotropic effects, are known to inhibit adhesion formation in murine models, but the same has not been assessed in humans. Frank I. Scott, University of Colorado Anschutz Medical Campus, Aurora, and colleagues aimed to assess whether the use of statin at the time of intra-abdominal surgery is associated with ARCs reduction.

The study involved two separate retrospective cohort studies (The Health Improvement Network [THIN] and Optum's Clinformatics Data Mart [Optum]) that compared adults receiving statins versus people who did not receive statins at the time of intra-abdominal surgery.

It included people undergoing intra-abdominal surgery from January 1, 1996, to December 31, 2013, in the United Kingdom and from January 1, 2000, to December 31, 2016, in the US. People with obstructive events before surgery or a history of inflammatory bowel disease were excluded. Data analysis was performed from September 1, 2012, to November 24, 2020.

The primary outcome was ARCs, defined as small-bowel obstruction or need for adhesiolysis, occurring after surgery.

For THIN, a total of 148,601 and for Optum 1,188,217 individuals met the inclusion criteria.

Key Findings of the Study

• A total of 2,060 participants (1.4%) experienced an ARC in THIN and 54,136 (4.6%) in Optum.
• Statin use at the time of surgery was associated with decreased risk of ARCs (THIN: adjusted hazard ratio [HR], 0.81; Optum: adjusted HR, 0.92).
• Similar associations were appreciated between statins and small-bowel obstruction (THIN: adjusted HR, 0.80; Optum: adjusted HR, 0.88).

"This research suggests that statin use may be significantly associated with a decreased probability of ARCs and small-bowel obstructions (SBOs) after intra-abdominal surgery. Future prospective randomized clinical trials of this inexpensive, well-tolerated therapy will be required to confirm these findings," concluded the authors.

The study titled, "Association Between Statin Use at the Time of Intra-abdominal Surgery and Postoperative Adhesion-Related Complications and Small-Bowel Obstruction," is published in the journal JAMA Network Open.

DOI: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2775824