The Effect of ACE Inhibitors/ARBs Withdrawal on the Risk of Postoperative Complications in Abdominal Surgery
A significant proportion of patients undergoing non-cardiac surgery receive therapy with angiotensin converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs), which are usually prescribed for treatment of arterial hypertension and CHF. Current guidelines fail to provide clear conse...
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Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
2023-10-01
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| Online Access: | https://www.reanimatology.com/rmt/article/view/2372 |
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| author | N. V. Trembach M. A. Magomedov V. G. Krasnov L. Yu. Chernienko S. N. Shevyrev A. S. Popov E. V. Tyutyunova S. N. Vatutin A. A. Dmitriev V. V. Fisher E. V. Volkov I. V. Yatsuk V. E. Khoronenko M. M. Shemetova A. I. Gritsan S. V. Sorsunov P. V. Dunts A. Zh. Bayalieva A. M. Ovezov A. A. Pivovarova D. V. Martynov O. A. Batigyan K. M. Lebedinsky A. N. Kuzovlev D. E. Fedunets T. S. Musaeva R. V. Veiler I. B. Zabolotskikh |
| author_facet | N. V. Trembach M. A. Magomedov V. G. Krasnov L. Yu. Chernienko S. N. Shevyrev A. S. Popov E. V. Tyutyunova S. N. Vatutin A. A. Dmitriev V. V. Fisher E. V. Volkov I. V. Yatsuk V. E. Khoronenko M. M. Shemetova A. I. Gritsan S. V. Sorsunov P. V. Dunts A. Zh. Bayalieva A. M. Ovezov A. A. Pivovarova D. V. Martynov O. A. Batigyan K. M. Lebedinsky A. N. Kuzovlev D. E. Fedunets T. S. Musaeva R. V. Veiler I. B. Zabolotskikh |
| author_sort | N. V. Trembach |
| collection | DOAJ |
| description | A significant proportion of patients undergoing non-cardiac surgery receive therapy with angiotensin converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs), which are usually prescribed for treatment of arterial hypertension and CHF. Current guidelines fail to provide clear consensus on whether it is worth discontinuing ACEi/ARBs before non-cardiac surgery. The aim of this research was to assess the contribution of pre-op ACEi/ARBs withdrawal to the development of postoperative complications in patients after abdominal surgery using data from STOPRISK database.Materials and methods. Data of 1945 patients from of the STOPRISK database was used for the analysis. Patients were retrospectively divided into two groups: first group (N=471, 24.2%) included patients subjected to ACEi/ARBs withdrawal 24 hours before surgery, second group (N=1474, 75.8%) included patients continuing on ACEi/ARBs therapy. The 30-day outcomes were analyzed — postoperative complications (acute kidney injury, acute respiratory distress syndrome, anastomosis failure, arrhythmias, circulatory arrest, cardiogenic pulmonary edema, postoperative delirium, myocardial infarction, pneumonia, ileus, postoperative bleeding, pulmonary embolism, acute cerebrovascular accident, wound infection) and mortality. We were not evaluating intraoperative and postoperative arterial hypotension and hypertension, we analyzed the use of vasopressors as a surrogate marker. ACEi/ARBs re-initiation after surgery was not evaluated.Results. One or more post-operative complications were documented in 113 patients (5.8%). Only postoperative delirium was more common in patients (1.06% vs. 0.27%, P=0.027) after ACEi/ARBs withdrawal 24 hours before surgery, the difference reached statistical significance. Sub-analysis in the group of patients with arterial hypertension as the only comorbidity showed no statistically significant differences in the outcomes. Sub-analysis in the group of patients with CFH showed higher incidence of postoperative delirium after ACEi/ARBs withdrawal (2.68% vs. 0.6%, P=0.023). The logistic regression analysis showed that the risk of developing postoperative delirium is influenced by age, vasopressor support, and ACEi/ARBs withdrawal (the area under the curve for the model was 0.92 (0.90–0.93).Conclusion. Rates of pre-op ACEi/ARBs withdrawal (24.2%) are consistent with published data. In the entire cohort, ACEi/ARBs withdrawal resulted in higher incidence of postoperative delirium, as well as in the subgroup of patients with CHF, while ACEi/ARBs withdrawal in the subgroup of patients with arterial hypertension had no influence on postop complications.ACEi/ARBs withdrawal, along with hemodynamic instability and older age, contributes to the development of postoperative delirium, which is the subject of future research. |
| format | Article |
| id | doaj-art-2019dc30bded447aaced676884fb65c0 |
| institution | DOAJ |
| issn | 1813-9779 2411-7110 |
| language | English |
| publishDate | 2023-10-01 |
| publisher | Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia |
| record_format | Article |
| series | Общая реаниматология |
| spelling | doaj-art-2019dc30bded447aaced676884fb65c02025-08-20T02:59:35ZengFederal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, RussiaОбщая реаниматология1813-97792411-71102023-10-01195213010.15360/1813-9779-2023-5-23281923The Effect of ACE Inhibitors/ARBs Withdrawal on the Risk of Postoperative Complications in Abdominal SurgeryN. V. Trembach0M. A. Magomedov1V. G. Krasnov2L. Yu. Chernienko3S. N. Shevyrev4A. S. Popov5E. V. Tyutyunova6S. N. Vatutin7A. A. Dmitriev8V. V. Fisher9E. V. Volkov10I. V. Yatsuk11V. E. Khoronenko12M. M. Shemetova13A. I. Gritsan14S. V. Sorsunov15P. V. Dunts16A. Zh. Bayalieva17A. M. Ovezov18A. A. Pivovarova19D. V. Martynov20O. A. Batigyan21K. M. Lebedinsky22A. N. Kuzovlev23D. E. Fedunets24T. S. Musaeva25R. V. Veiler26I. B. Zabolotskikh27Kuban State Medical University, Ministry of Health of Russia; Regional Clinical Hospital No. 2, Ministry of Health of the Krasnodar AreaN.I. Pirogov City Clinical Hospital № 1, Moscow Department of Health; N. I. Pirogov Russian National Medical Research University, Ministry of Health of RussiaN.I. Pirogov City Clinical Hospital № 1, Moscow Department of HealthN.I. Pirogov City Clinical Hospital № 1, Moscow Department of HealthN.I. Pirogov City Clinical Hospital № 1, Moscow Department of HealthVolgograd State Medical University, Ministry of Health of RussiaVolgograd Regional Clinical Hospital No. 1City Clinical Emergency Hospital No. 25Kuban State Medical University, Ministry of Health of RussiaStavropol Regional Clinical Hospital; Stavropol State Medical University, Ministry of Health of RussiaStavropol Regional Clinical Hospital; Stavropol State Medical University, Ministry of Health of RussiaStavropol State Medical University, Ministry of Health of RussiaP. A. Herzen Research Institute of Oncology,branch of the National Medical Research Center for Radiology, Russian Ministry of HealthP. A. Herzen Research Institute of Oncology,branch of the National Medical Research Center for Radiology, Russian Ministry of HealthRegional Clinical Hospital; Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of RussiaRegional Clinical Hospital; Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of RussiaRegional Clinical Hospital No. 2Republican Clinical Hospital, Ministry of Health of the Republic of TatarstanM. F. Vladimirsky Moscow Regional Research Clinical InstituteM. F. Vladimirsky Moscow Regional Research Clinical InstituteRostov State Medical UniversityRostov State Medical UniversityI. I. Mechnikov North-Western State Medical University, Ministry of Health of Russia; V. A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and RehabilitologyV. A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and RehabilitologyKuban State Medical University, Ministry of Health of RussiaKuban State Medical University, Ministry of Health of Russia; Regional Clinical Hospital No. 2, Ministry of Health of the Krasnodar AreaKuban State Medical University, Ministry of Health of Russia; Regional Clinical Hospital No. 2, Ministry of Health of the Krasnodar AreaKuban State Medical University, Ministry of Health of Russia; Regional Clinical Hospital No. 2, Ministry of Health of the Krasnodar Area; V. A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and RehabilitologyA significant proportion of patients undergoing non-cardiac surgery receive therapy with angiotensin converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs), which are usually prescribed for treatment of arterial hypertension and CHF. Current guidelines fail to provide clear consensus on whether it is worth discontinuing ACEi/ARBs before non-cardiac surgery. The aim of this research was to assess the contribution of pre-op ACEi/ARBs withdrawal to the development of postoperative complications in patients after abdominal surgery using data from STOPRISK database.Materials and methods. Data of 1945 patients from of the STOPRISK database was used for the analysis. Patients were retrospectively divided into two groups: first group (N=471, 24.2%) included patients subjected to ACEi/ARBs withdrawal 24 hours before surgery, second group (N=1474, 75.8%) included patients continuing on ACEi/ARBs therapy. The 30-day outcomes were analyzed — postoperative complications (acute kidney injury, acute respiratory distress syndrome, anastomosis failure, arrhythmias, circulatory arrest, cardiogenic pulmonary edema, postoperative delirium, myocardial infarction, pneumonia, ileus, postoperative bleeding, pulmonary embolism, acute cerebrovascular accident, wound infection) and mortality. We were not evaluating intraoperative and postoperative arterial hypotension and hypertension, we analyzed the use of vasopressors as a surrogate marker. ACEi/ARBs re-initiation after surgery was not evaluated.Results. One or more post-operative complications were documented in 113 patients (5.8%). Only postoperative delirium was more common in patients (1.06% vs. 0.27%, P=0.027) after ACEi/ARBs withdrawal 24 hours before surgery, the difference reached statistical significance. Sub-analysis in the group of patients with arterial hypertension as the only comorbidity showed no statistically significant differences in the outcomes. Sub-analysis in the group of patients with CFH showed higher incidence of postoperative delirium after ACEi/ARBs withdrawal (2.68% vs. 0.6%, P=0.023). The logistic regression analysis showed that the risk of developing postoperative delirium is influenced by age, vasopressor support, and ACEi/ARBs withdrawal (the area under the curve for the model was 0.92 (0.90–0.93).Conclusion. Rates of pre-op ACEi/ARBs withdrawal (24.2%) are consistent with published data. In the entire cohort, ACEi/ARBs withdrawal resulted in higher incidence of postoperative delirium, as well as in the subgroup of patients with CHF, while ACEi/ARBs withdrawal in the subgroup of patients with arterial hypertension had no influence on postop complications.ACEi/ARBs withdrawal, along with hemodynamic instability and older age, contributes to the development of postoperative delirium, which is the subject of future research.https://www.reanimatology.com/rmt/article/view/2372angiotensin converting enzyme inhibitorsangiotensin ii receptor blockerspostoperative complicationsabdominal surgery |
| spellingShingle | N. V. Trembach M. A. Magomedov V. G. Krasnov L. Yu. Chernienko S. N. Shevyrev A. S. Popov E. V. Tyutyunova S. N. Vatutin A. A. Dmitriev V. V. Fisher E. V. Volkov I. V. Yatsuk V. E. Khoronenko M. M. Shemetova A. I. Gritsan S. V. Sorsunov P. V. Dunts A. Zh. Bayalieva A. M. Ovezov A. A. Pivovarova D. V. Martynov O. A. Batigyan K. M. Lebedinsky A. N. Kuzovlev D. E. Fedunets T. S. Musaeva R. V. Veiler I. B. Zabolotskikh The Effect of ACE Inhibitors/ARBs Withdrawal on the Risk of Postoperative Complications in Abdominal Surgery Общая реаниматология angiotensin converting enzyme inhibitors angiotensin ii receptor blockers postoperative complications abdominal surgery |
| title | The Effect of ACE Inhibitors/ARBs Withdrawal on the Risk of Postoperative Complications in Abdominal Surgery |
| title_full | The Effect of ACE Inhibitors/ARBs Withdrawal on the Risk of Postoperative Complications in Abdominal Surgery |
| title_fullStr | The Effect of ACE Inhibitors/ARBs Withdrawal on the Risk of Postoperative Complications in Abdominal Surgery |
| title_full_unstemmed | The Effect of ACE Inhibitors/ARBs Withdrawal on the Risk of Postoperative Complications in Abdominal Surgery |
| title_short | The Effect of ACE Inhibitors/ARBs Withdrawal on the Risk of Postoperative Complications in Abdominal Surgery |
| title_sort | effect of ace inhibitors arbs withdrawal on the risk of postoperative complications in abdominal surgery |
| topic | angiotensin converting enzyme inhibitors angiotensin ii receptor blockers postoperative complications abdominal surgery |
| url | https://www.reanimatology.com/rmt/article/view/2372 |
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