Abstract
Background
Postoperative arrhythmias are associated with increased morbidity and mortality in
total joint arthroplasty (TJA) patients. HMG-CoA (3-hydroxy-3-methyl-glutaryl-CoA)
reductase inhibitors (statins) decrease atrial fibrillation rates after cardiac surgery,
but it is unknown if this cardioprotective effect is maintained after joint reconstruction
surgery. We aim to determine if perioperative statin use decreases the incidence of
90-day postoperative arrhythmias in patients undergoing primary TJA.
Methods
We performed a single-center retrospective cohort study in which 231 primary TJA patients
(109 hips, 122 knees) received simvastatin 80 mg daily during their hospitalization
as part of a single surgeon’s standard postoperative protocol. This cohort was matched
to 966 primary TJA patients (387 hips and 579 knees) that did not receive simvastatin.
New-onset arrhythmias (bradycardia, atrial fibrillation/tachycardia/flutter, paroxysmal
supraventricular tachycardia, and ventricular tachycardia) and complications (readmissions,
thromboembolism, infection, and dislocation) within 90 days of the procedure were
documented. Categorical variables were analyzed using Fisher’s exact tests. Our study
was powered to detect a 3% difference in arrhythmia rates.
Results
Within 90 days postoperatively, arrhythmias occurred in 1 patient (0.4%) who received
a perioperative statin, 39 patients (4.0%) who did not receive statins (P = .003), and 24 patients (4.2%) who were on outpatient statins (P = .005). This is 10-fold reduction in the relative risk of developing a postoperative
arrhythmia within 90 days of arthroplasty and an absolute risk reduction of 3.6%.
Conclusion
Treating as few as 28 patients with perioperative simvastatin prevents one new cardiac
arrhythmia within 90 days in statin-naïve patients undergoing TJA.
Keywords
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Article info
Publication history
Published online: May 24, 2021
Accepted:
May 12,
2021
Received in revised form:
March 15,
2021
Received:
November 30,
2020
Footnotes
Source of Funding: No funding was provided for this investigation. D.F.A. was supported in part by NIH-NCATS (KL2TR003143). The content is solely the responsibility of the authors and does not reflect the official views of the NIH. These funding sources had no role in the study design, data collection, analysis, interpretation of data, writing the report, or the decision to submit the findings for publication.
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2021.05.022.
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