Association Between Statin Use at the Time of Intra-abdominal Surgery and Postoperative Adhesion-Related Complications and Small-Bowel Obstruction

• Published in: JAMA network open 2021-02, Vol.4 (2), p.e2036315-e2036315
• Main Authors: Scott, Frank I, Vajravelu, Ravy K, Mamtani, Ronac, Bianchina, Nicholas, Mahmoud, Najjia, Hou, Jason K, Wu, Qufei, Wang, Xingmei, Haynes, Kevin, Lewis, James D
• Format: Article
• Language: English
• Subjects: Abdomen; Abdomen - surgery; Abdominal surgery; Adult; Aged; Cohort Studies; Digestive System Surgical Procedures; Female; Gynecologic Surgical Procedures; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Intestinal obstruction; Intestinal Obstruction - epidemiology; Intestine, Small; Male; Middle Aged; Online Only; Original Investigation; Postoperative Complications - epidemiology; Postoperative Complications - surgery; Proportional Hazards Models; Protective Factors; Retrospective Studies; Small intestine; Statins; Surgery; Surgical Procedures, Operative; Tissue Adhesions - epidemiology; Tissue Adhesions - surgery; United Kingdom - epidemiology; United States - epidemiology; Urologic Surgical Procedures; Vascular Surgical Procedures
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2020.36315

Adhesion-related complications (ARCs), including small-bowel obstruction, are common complications of intra-abdominal surgery. Statins, which have antifibrotic pleiotropic effects, inhibit adhesion formation in murine models but have not been assessed in humans. To assess whether statin use at the time of intra-abdominal surgery is associated with a reduction in ARCs. These 2 separate retrospective cohort studies (The Health Improvement Network [THIN] and Optum's Clinformatics Data Mart [Optum]) compared adults receiving statins with those not receiving statins at the time of intra-abdominal surgery. Individuals 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 were included in the study. Those 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 exposure was statin use at the time of surgery. The primary outcome was ARCs, defined as small-bowel obstruction or need for adhesiolysis, occurring after surgery. Sensitivity analyses included statin use preceding but not concurrent with surgery, fibrate use, and angiotensin-converting enzyme inhibitor use. All analyses were adjusted for age, sex, and conditions associated with microvascular disease, such as hypertension, hyperlipidemia, obesity, and tobacco use; surgical approach and site; and diagnosis of a malignant tumor. A total of 148 601 individuals met the inclusion criteria for THIN (mean [SD] age, 49.6 [17.7] years; 70.1% female) and 1 188 217 for Optum (mean [SD] age, 48.2 [16.4] years; 72.6% female). A total of 2060 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; 95% CI, 0.71-0.92; Optum: adjusted HR, 0.92; 95% CI, 0.90-0.95). Similar associations were appreciated between statins and small-bowel obstruction (THIN: adjusted HR, 0.80; 95% CI, 0.70-0.92; Optum: adjusted HR, 0.88; 95% CI, 0.85-0.91). This study's findings suggest that, among individuals in 2 separate cohorts undergoing intra-abdominal surgery, statin use may be associated with a reduced risk of postoperative ARCs. Statins may represent an inexpensive, well-tolerated pharmacologic option for preventing ARCs.