Simvastatin may prevent postoperative cardiac arrhythmias in
Postoperative arrhythmias are associated with increased morbidity and mortality in total joint arthroplasty (TJA) patients. HMG-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. Researchers aim to determine if perioperative statin use decreases the incidence of 90-day post-operative arrhythmias in patients undergoing primary TJA.

Researchers 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. This study was powered to detect a 3% difference in arrhythmia rates.

-- 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, and 24 patients (4.2%) who were on outpatient statins.

-- 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%.

Conclusively, treating as few as 28 patients with perioperative Simvastatin prevents one new cardiac arrhythmia within 90-days in statin-naïve patients undergoing total joint arthroplasty.