Abstract
Research Type:
Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies
Introduction/Purpose:
Ankle arthrodesis (AA) is an established treatment for end-stage ankle arthritis, yet the impact of perioperative statin use on incidence of postoperative complications following AA has not been well-explored. Statins, known for their pleiotropic effects, including anti-inflammatory and endothelial stabilizing properties, have been shown in total hip arthroplasty (THA) studies to reduce venous thromboembolism (VTE) events. However, their role in modulating cardiovascular and cerebrovascular outcomes in the context of AA is less clear. The goal of this study was to determine whether perioperative statin use is associated with differences in rates of any adverse events and specific complications at 90 days and 1 year following AA.
Methods:
We performed a retrospective analysis using the TriNetX research network, which aggregates de-identified records from 104 healthcare organizations. Patients undergoing open ankle arthrodesis (CPT 27870) were stratified into two cohorts based on statin exposure within 30 days before surgery and absence of prior VTE history. Propensity score matching on age, race, sex, type II diabetes, coronary artery disease, smoking, and body mass index yielded 2,413 matched pairs. Primary endpoints included a composite any adverse event (comprising death, wound disruption, pulmonary embolism, acute myocardial infarction, cerebral infarct, transfusion, deep vein thrombosis, surgical site infection (SSI), and sepsis) and individual complication rates. Outcomes with ≤10 events were excluded. Incidence rates, odds ratios (ORs) with 95% confidence intervals, and p values were calculated for both the 90-day and 1-year time windows.
Results:
After matching for demographics and comorbidities, the overall 90-day adverse event rate did not differ significantly between statin users and non-users (15.3% vs. 14.1%, p = 0.22). Thromboembolic events did not significantly differ, with deep vein thrombosis occurring in 0.7% of statin users and 0.4% of non-users (p = 0.24) and pulmonary embolism in 0.5% versus 0.4%, respectively (p = 0.67). However, statin users experienced significantly higher rates of acute myocardial infarction (2.2% vs. 1.1%; p = 0.002) and emergency department visits (12.1% vs. 9.9%; p = 0.013). Rates of dehiscence, cerebral infarct, transfusion, SSI, hematoma, and sepsis were similar between groups at 90 days and 2 years.
Conclusion:
Contrary to findings THA, where preoperative statin use was linked to reduced postoperative thromboembolic events, our analysis of propensity-matched cohorts of open AA patients revealed no significant difference in the incidence of deep vein thrombosis or pulmonary embolism between statin users and non-users. Preoperative statin use is not associated with the same protective effect on thromboembolic events in ankle arthrodesis as was seen in THA.