Statin use and postoperative atrial fibrillation after major noncardiac surgery

BACKGROUND Although statin lipid-lowering medications likely reduce perioperative ischemic complications, few data exist to describe statins' effects on risk for and outcomes of atrial fibrillation following noncardiac surgery. OBJECTIVE To examine the association between treatment with statin medications and clinically significant postoperative atrial fibrillation (POAF) following major noncardiac surgery. METHODS A retrospective cohort study of patients aged 18 years or older who underwent major noncardiac surgery between January 1, 2008, and December 31, 2008. Cases of clinically significant POAF were selected by using a combination of International Classification of Diseases-9 codes and clinical variables. We defined statin users as those whose pharmacy data included a charge for a statin drug on the day of surgery, the day after surgery, or both. RESULTS Of 370,447 patients, 10,957 (3.0%) developed clinically significant POAF; overall, 79,871 (21.6%) received a perioperative statin. Patients receiving statins were generally older (68.8 vs 61.1 years; P<.001) and more likely to be receiving a beta-blocker (50.3% vs 21.6%; P<.001). Statin use was associated with a lower unadjusted rate of POAF (2.6% vs 3.0%; P<.001). After adjustment for patient risk factors and surgery type, odds for POAF remained significantly lower among statin-treated patients (adjusted odds ratio = 0.79; 95% confidence interval = 0.71-0.87; P<.001). Statin use was not associated with differences in cost, length of stay, or mortality among patients who developed POAF. CONCLUSION Treatment with statin agents appears to be associated with a lower risk for clinically significant POAF following major noncardiac surgery.