Pre-surgery statin use and outcomes in operated chronic subdural haematomas: a nationwide cohort study
Jussi P Posti, Aleksi Tornio, Jori O Ruuskanen, Rahul Raj, Teemu Luoto, Pihla Tommiska, Ville KytöAbstract
Background
Chronic subdural haematoma (cSDH) is common in older adults, and medication exposures may influence postoperative outcomes. We assessed whether pre-surgery statin use is associated with short- and long-term outcomes.
Methods
We conducted a nationwide registry study of adults undergoing surgical evacuation of traumatic or non-traumatic cSDH (6/2004–12/2018) in Finnish university hospitals. Pre-surgery statin use was defined from national prescription records using a pill-counting approach. The primary outcome was 30-day all-cause mortality. Secondary outcomes were 30-day reoperation and length of hospital stay. Tertiary outcomes were 1-year mortality and reoperation. Mortality was analysed using Cox regression; reoperation with Fine–Gray models accounting for competing risk of death.
Results
The cohort included 9001 patients, of whom 2450 (27.2%) used statins. Thirty-day mortality was 3.3% in statin users and 4.5% in non-users, with lower adjusted mortality among statin users (HR 0.57; 95% CI 0.44–0.73). Reoperation within 30 days (n = 897) was similar between groups (sub-distribution HR 1.08; 95% CI 0.97–1.21). Hospital stay was shorter in statin users (22.1 ± 62.7 vs 26.3 ± 77.5 days; adjusted P = .002). At 1 year, mortality remained lower in statin users (13.3% vs 15.4%; HR 0.66; 95% CI 0.58–0.75), with no difference in reoperation (sub-distribution HR 1.09; 95% CI 0.96–1.22).
Conclusion
In this nationwide cohort of surgically treated cSDH patients, pre-surgery statin use was associated with lower short- and long-term mortality and shorter hospital stay, while reoperation rates were similar between statin users and non-users.