Type 2 statin use increased perioperative blood loss in primary reverse total shoulder arthroplasty

Statins (hydroxyl-methylglutaryl-coenzyme-A reductase inhibitors) are commonly prescribed for managing hypercholesterolemia. Besides lowering cholesterol, statins have been reported to have anticoagulant and antiplatelet effects. This study aimed to analyze postoperative blood loss by standardizing the surgical procedure for reverse total shoulder arthroplasty and evaluate the effect of statin use on bleeding.

A retrospective review of prospectively collected primary RSA cases was conducted, identifying the use and types of statins: type 1 (naturally derived) and type 2 (synthetic). Those taking anticoagulants and antiplatelet medications were excluded. Multiple regression models were utilized to identify the predictors of estimated blood loss. Blood loss was calculated using preoperative and third-day postoperative hematocrit values. Preoperative factors, surgery-related factors (surgical time, stem length), and the administration of tranexamic acid were collected and analyzed.

A total of 243 cases were included. Statins were administered in 62 cases (26%). The estimated blood loss was 826 ± 332 ml in the statin-use group and 738 ± 308 ml in the statin-nonuse group. The regression analysis identified type 2 statin use, male sex, tranexamic acid administration, and ASA classification as statistically significant predictors of total blood loss (P < .05). Specifically, type 2 statin use was associated with an estimated increase in bleeding volume of 148 mL (95% confidence interval: 54 to 242 mL).

The current study showed that type 2 statin use was a significant predictor of increased perioperative blood loss. However, the anticipated increase in bleeding was not significant, and whether the risk of bleeding outweighs the benefits of statin use should be decided on an individual basis.