The Impact of Statin Therapy on Postoperative Short- and Long-term Mortality and Morbidity After Non-Cardiac Surgery.

AIMS: Statins' anti-inflammatory and endothelial-stabilising effects suggest perioperative value, but trials of de novo initiation were discredited following research misconduct. Whether established preoperative statin therapy lowers postoperative mortality dose-dependently remains unclear. METHODS: We studied 56,362 patients aged ≥45 years undergoing non-cardiac surgery at two university hospitals (2016-2023). Preoperative statin exposure was assessed as status (any vs none), intensity (high vs low/intermediate), and regimen (high vs low/intermediate vs none). Primary outcomes were 30- and 365-day mortality. Inverse probability of treatment weighting, using random forest-estimated propensity scores targeting the average treatment effect in the treated, was applied to balance measured confounders. Associations were estimated with weighted Cox regression. RESULTS: Overall, 372 patients (0.6%) died within 30 days and 3,735 (6.6%) within 365 days. After weighting, all covariates were balanced. Statin therapy showed a directionally consistent but non-significant association with lower 30-day mortality (HR 0.78; 95% CI 0.57-1.07), and was associated with lower 365-day mortality (HR 0.81; 95% CI 0.73-0.90; ARD -1.2 percentage points; number needed to treat 83). A dose-response relationship was evident: versus no statin, high-intensity therapy showed a 29% lower hazard (HR 0.71; 95% CI 0.60-0.83; ARD -2.3 points) and low/intermediate-intensity a 16% lower hazard (HR 0.84; 95% CI 0.74-0.96). Findings were consistent across sensitivity analyses. CONCLUSIONS: Among adults undergoing non-cardiac surgery, established preoperative statin therapy was associated with dose-dependent lower 365-day mortality. These findings suggest perioperative statin continuation as a preventive strategy and warrant confirmation in a randomised trial.