BACKGROUND: Angiotensin-converting enzyme inhibitors (ACE-Is) are a widely used class of cardiovascular medication. However, limited data exist on the risks of postoperative nonresumption of an ACE-I. OBJECTIVE: To evaluate the factors and 30-day mortality risks associated with the postoperative nonresumption of an ACE-I. DESIGN: A retrospective cohort study. SETTING: Veterans Affairs (VA) Healthcare System. PATIENTS: A total of 294,505 admissions in 240,978 patients with multiple preoperative prescription refills (>3) for an ACE-I who underwent inpatient surgery from calendar years 1999 to 2012. INTERVENTION: None. MEASUREMENTS: We classified surgical admissions based upon the timing of postoperative resumption of an ACE-I prescription from the day of surgery through postoperative days 0 to 14 and 15 to 30, and collected 30-day mortality data. We evaluated the relationship between 30-day mortality and the nonresumption of an ACE-I from postoperative day 0 to 14 using proportional hazard regression models, adjusting for patient- and hospital-level risk factors. Sensitivity analyses were conducted using more homogeneous subpopulations and propensity score models. RESULTS: Twenty-five percent of our cohort did not resume an ACE-I during the 14 days following surgery. Nonresumption of an ACE-I within postoperative day 0 to 14 was independently associated with increased 30-day mortality (hazard ratio: 3.44; 95% confidence interval: 3.30-3.60; P < 0.001) compared to the restart group. Sensitivity analyses maintained this relationship. CONCLUSIONS: Nonresumption of an ACE-I is common after major inpatient surgery in the large VA Health Care System. Restarting of an ACE-I within postoperative day 0 to 14 is, however, associated with decreased 30-day mortality. Careful attention to the issue of timely reinstitution of chronic medications such as an ACE-I is indicated.
BACKGROUND: Angiotensin-converting enzyme inhibitors (ACE-Is) are a widely used class of cardiovascular medication. However, limited data exist on the risks of postoperative nonresumption of an ACE-I. OBJECTIVE: To evaluate the factors and 30-day mortality risks associated with the postoperative nonresumption of an ACE-I. DESIGN: A retrospective cohort study. SETTING: Veterans Affairs (VA) Healthcare System. PATIENTS: A total of 294,505 admissions in 240,978 patients with multiple preoperative prescription refills (>3) for an ACE-I who underwent inpatient surgery from calendar years 1999 to 2012. INTERVENTION: None. MEASUREMENTS: We classified surgical admissions based upon the timing of postoperative resumption of an ACE-I prescription from the day of surgery through postoperative days 0 to 14 and 15 to 30, and collected 30-day mortality data. We evaluated the relationship between 30-day mortality and the nonresumption of an ACE-I from postoperative day 0 to 14 using proportional hazard regression models, adjusting for patient- and hospital-level risk factors. Sensitivity analyses were conducted using more homogeneous subpopulations and propensity score models. RESULTS: Twenty-five percent of our cohort did not resume an ACE-I during the 14 days following surgery. Nonresumption of an ACE-I within postoperative day 0 to 14 was independently associated with increased 30-day mortality (hazard ratio: 3.44; 95% confidence interval: 3.30-3.60; P < 0.001) compared to the restart group. Sensitivity analyses maintained this relationship. CONCLUSIONS: Nonresumption of an ACE-I is common after major inpatient surgery in the large VA Health Care System. Restarting of an ACE-I within postoperative day 0 to 14 is, however, associated with decreased 30-day mortality. Careful attention to the issue of timely reinstitution of chronic medications such as an ACE-I is indicated.
Authors: Marlies Ostermann; Lakhmir S Chawla; Lui G Forni; Sandra L Kane-Gill; John A Kellum; Jay Koyner; Patrick T Murray; Claudio Ronco; Stuart L Goldstein Journal: Br J Clin Pharmacol Date: 2017-12-01 Impact factor: 4.335
Authors: Andrew D Shaw; John A Kellum; John R Prowle; Lui G Forni; Max Bell; Michelle S Chew; Mark Edwards; Morgan E Grams; Michael P W Grocott; Kathleen D Liu; David McIlroy; Patrick T Murray; Marlies Ostermann; Alexander Zarbock; Sean M Bagshaw; Raquel Bartz; Samira Bell; Azra Bihorac; Tong J Gan; Charles E Hobson; Michael Joannidis; Jay L Koyner; Denny Z H Levett; Ravindra L Mehta; Timothy E Miller; Michael G Mythen; Mitra K Nadim; Rupert M Pearse; Thomas Rimmele; Claudio Ronco Journal: Nat Rev Nephrol Date: 2021-05-11 Impact factor: 28.314