Withholding ACEi or ARB on the morning of surgery did not significantly affect rates of postoperative acute kidney injury (18% vs 13%, P=0.25) or atrial fibrillation compared to continuation.
Observational (n=323)
Does withholding ACEi or ARB on the morning of surgery improve perioperative outcomes (fluid/vasopressor use, AKI, AF) in surgical patients?
Withholding ACEi or ARB on the morning of surgery did not significantly affect intraoperative fluid or vasopressor requirements, nor rates of postoperative AKI or AF, though the study was limited by sample size and potential confounding.
Absolute Event Rate: 18% vs 13%
p-value: p=0.25
Previous studies have shown that patients continuing angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers on the day of surgery are more likely to have significant intraoperative hypotension, higher rates of postoperative acute kidney injury, and lower incidences of postoperative atrial fibrillation. However, many of these studies were prone to bias and confounding, and questions remain over the validity of these outcomes. This observational, before-and-after quality improvement audit aimed to assess the effect of withholding these medications on the morning of surgery. We recruited 323 participants, with 83 (26%) having their preoperative angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB) withheld on the day of surgery. There were only very small Spearman rank-order correlations between time since last dose of these medications (rho -0.12, P=0.057) and intraoperative and recovery room intravenous fluid administration (rho -0.11, P=0.042). There was no statistically significant difference between the continued or withheld groups in vasopressor (metaraminol use 3.5 1.5-8.3 mg versus 3.5 1.5-8.5 mg, P=0.67) or intravenous fluid administration (1000 ml 800-1500 ml versus 1000 800-1500 ml, P=0.096), nor rates of postoperative acute kidney injury (13% vs 18%, P=0.25) or atrial fibrillation (15% versus 18%, P=0.71). This audit found no significant differences in measured outcomes between the continued or withheld ACEi/ARB groups. This finding should be interpreted with caution due to the possibility of confounding and an insufficient sample size. However, as the finding is in contrast to many previous studies, future prospective randomised clinical trials are required to answer this important question.
Vijay et al. (Sun,) führten eine Beobachtungsstudie an Patienten durch, die mit ACEi oder ARB behandelt wurden und sich einer Operation unterzogen (n=323). Das Zurückhalten von ACEi oder ARB im Vergleich zum Fortsetzen von ACEi oder ARB wurde auf postoperative akute Nierenverletzung (p=0.25) evaluiert. Das Zurückhalten von ACEi oder ARB am Morgen der Operation hatte keinen signifikanten Einfluss auf die Raten der postoperativen akuten Nierenverletzung (18 % vs. 13 %, P=0.25) oder Vorhofflimmern im Vergleich zur Fortsetzung.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: