Background: Studies have shown that early exposure to statins preoperatively have been associated with significant reductions in perioperative mortality and improved post-operative outcomes [1]. Despite guideline recommendations, use of statin therapy remains sub-optimal [2]. A retrospective study at our institution revealed over 40% of patients that presented to our preoperative optimization clinic were not on appropriate evidence-based statin therapy [3]. With this in mind, we implemented a quality improvement project to improve perioperative statin use and dosing by implementing a new screening and prescribing protocol within our surgical optimization clinic.
Methods: In this quality improvement project, we provided health care providers with automated data from the electronic health record and an algorithm, based on the ACC/AHA cholesterol guidelines, to guide decision making regarding statin therapy. Implementation also incorporated regular education to the residents and staff in the clinic, as well as changes to nursing workflow. The implementation period was from January to June 2019, and data was collected on statin prescriptions and dose adjustments. The proportion of patients with corrected statin therapy was the primary outcome.
Results: A total of 248 patients were seen in the perioperative clinic in the six-month period. 116 (46.8%) of those patients were either on an appropriate dose statin or did not qualify for needing a statin. 132 (53.2%) were not on an appropriate statin. Of those patients, 88 (66.7%) were not on a statin but should have been based on the guidelines, and 44 (33.3%) were on an inappropriately low dose of statin. With the implementation of our QI initiative, 18 of the patients who were not on an appropriate statin had a statin initiated during the visit, and 14 patients had their statin dose appropriately adjusted.
Conclusions: Statin prescription and adherence to guidelines remains sub-optimal despite profound evidence displaying the benefit of statin use. We were successful in initiating statins or appropriately modifying the dosage in 13% of patients seen in our surgical optimization clinic. While statin prescribing continues to be difficult, we found that the principal reason for not prescribing or correcting statin doses, despite our quality improvement initiative, comes from patients’ desire to discuss medication changes with their primary care physician. With this, expansion and implementation of this quality improvement project within primary care, or developing closer communication with our preoperative clinic and primary care physicians, may further increase adherence to guidelines.
