PMID- 24439325 OWN - NLM STAT- MEDLINE DCOM- 20140708 LR - 20211021 IS - 1097-6809 (Electronic) IS - 0741-5214 (Print) IS - 0741-5214 (Linking) VI - 59 IP - 6 DP - 2014 Jun TI - Perioperative management with antiplatelet and statin medication is associated with reduced mortality following vascular surgery. PG - 1615-21, 1621.e1 LID - S0741-5214(13)02284-2 [pii] LID - 10.1016/j.jvs.2013.12.013 [doi] AB - OBJECTIVE: Many patients undergoing vascular surgical procedures are not on appropriate medical therapy. This study sought to examine the variation and impact of antiplatelet (AP) and statin therapy on early and late mortality in patients undergoing vascular surgery in our region. METHODS: We studied all patients (n = 14,489) undergoing elective carotid endarterectomy (n = 6978), carotid stenting (n = 524), and suprainguinal (n = 763) and infrainguinal bypass (n = 3053), as well as patients with known coronary risk factors undergoing open (n = 1044) and endovascular (n = 2127) abdominal aortic aneurysm repair from 2005 to 2012 in the Vascular Study Group of New England. Optimal medical management was defined as treatment with both AP and statin agents, preoperatively and at discharge. We analyzed temporal, procedural, and center variation of medication use. Multivariable analyses were used to determine the adjusted impact of AP and statin therapy on 30-day mortality and 5-year survival. RESULTS: Optimal medical management improved over the study interval (55% in 2005 to 68% in 2012; P trend < .01) with carotid interventions having the highest rates of optimal medications use (carotid artery stenting, 78%; carotid endarterectomy, 74%) and abdominal aortic aneurysm repair in patients with known cardiac risk factors having the lowest (open, 57%; endovascular aneurysm repair, 56%). Optimal medication use varied by center as well (range, 40%-86%). Preoperative AP and statin use was associated with reduced 30-day mortality (odds ratio, 0.76; 95% confidence interval [CI], 0.5-1.05; P = .09). AP and statin prescription at discharge was additive in survival benefit with improved 5-year survival (hazard ratio, 0.5; 95% CI, 0.4-0.7; P < .01) that was consistent across procedure types. Patients prescribed AP and statin at discharge had 5-year survival of 79% (95% CI, 77%-81%) compared with only 61% (95% CI, 52%-68%; P < .001) for patients on neither medication. CONCLUSIONS: AP and statin therapy preoperatively and at discharge was associated with reduced 30-day mortality and an absolute 18% improved 5-year survival after vascular surgery. However, one-third of patients are suboptimally managed in real world practice. This demonstrates an opportunity for quality improvement that can substantially improve survival after vascular surgery. CI - Copyright (c) 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved. FAU - De Martino, Randall R AU - De Martino RR AD - Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn. Electronic address: demartino.randall@mayo.edu. FAU - Eldrup-Jorgensen, Jens AU - Eldrup-Jorgensen J AD - Maine Medical Center, Portland, Me. FAU - Nolan, Brian W AU - Nolan BW AD - Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. FAU - Stone, David H AU - Stone DH AD - Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. FAU - Adams, Julie AU - Adams J AD - Division of Vascular Surgery, University of Vermont College of Medicine, Burlington, Vt. FAU - Bertges, Daniel J AU - Bertges DJ AD - Division of Vascular Surgery, University of Vermont College of Medicine, Burlington, Vt. FAU - Cronenwett, Jack L AU - Cronenwett JL AD - Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. FAU - Goodney, Philip P AU - Goodney PP AD - Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. CN - Vascular Study Group of New England LA - eng GR - K08 HL105676/HL/NHLBI NIH HHS/United States GR - L32 MD006323/MD/NIMHD NIH HHS/United States GR - R21 HS021581/HS/AHRQ HHS/United States PT - Comparative Study PT - Journal Article DEP - 20140116 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 RN - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors) RN - 0 (Platelet Aggregation Inhibitors) SB - IM CIN - J Vasc Nurs. 2015 Mar;33(1):28-9. PMID: 25700736 MH - Aged MH - Arterial Occlusive Diseases/mortality/*surgery MH - Drug Therapy, Combination MH - Female MH - Follow-Up Studies MH - Humans MH - Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use MH - Male MH - New England/epidemiology MH - Perioperative Care/*methods MH - Platelet Aggregation Inhibitors/*therapeutic use MH - Postoperative Period MH - Prognosis MH - Retrospective Studies MH - Risk Factors MH - Survival Rate/trends MH - Time Factors MH - Treatment Outcome MH - Vascular Surgical Procedures/*mortality PMC - PMC4279233 MID - NIHMS569301 COIS- Author conflict of interest: none. EDAT- 2014/01/21 06:00 MHDA- 2014/07/09 06:00 PMCR- 2014/12/30 CRDT- 2014/01/21 06:00 PHST- 2013/10/21 00:00 [received] PHST- 2013/12/02 00:00 [revised] PHST- 2013/12/03 00:00 [accepted] PHST- 2014/01/21 06:00 [entrez] PHST- 2014/01/21 06:00 [pubmed] PHST- 2014/07/09 06:00 [medline] PHST- 2014/12/30 00:00 [pmc-release] AID - S0741-5214(13)02284-2 [pii] AID - 10.1016/j.jvs.2013.12.013 [doi] PST - ppublish SO - J Vasc Surg. 2014 Jun;59(6):1615-21, 1621.e1. doi: 10.1016/j.jvs.2013.12.013. Epub 2014 Jan 16.