(HealthDay News) — Preoperative metformin prescriptions may be associated with decreased postoperative mortality and readmission among patients with diabetes undergoing a major surgical procedure, according to a study published online in JAMA Surgery.

Katherine M. Reitz, MD, from the University of Pittsburgh School of Medicine, and colleagues used electronic health record data to identify 10,088 adults with diabetes who underwent a major operation with hospital admission (January 2010 to January 2016) at 15 community and academic hospitals within one health care system. Fifty-nine percent had preoperative metformin prescriptions. The analysis included 5460 propensity score-matched patients (mean age, 67.7 years; 53% women).

The researchers found that in the propensity score-matched cohort, preoperative metformin was associated with a reduced hazard for 90-day mortality (adjusted hazard ratio [HR], 0.72 [95% confidence interval (CI), 0.55 to 0.95]; absolute risk reduction [ARR], 1.28% [95% CI, 0.26 to 2.31]) and hazard of readmission at 30 days (ARR, 2.09% [95% CI, 0.35 to 3.82]; sub-HR, 0.84 [95% CI, 0.72 to 0.98]) and 90 days (ARR, 2.78% [95% CI, 0.62 to 4.95]; sub-HR, 0.86 [95% CI, 0.77 to 0.97]). Preoperative inflammation was lower in those with metformin prescriptions versus those without (mean neutrophil-to-leukocyte ratio, 4.5 [95% CI, 4.3 to 4.6] vs 5.0 [95% CI, 4.8 to 5.3]).

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“The advantages are likely not disease specific, but instead the pleiotropic properties may modulate the stress response generated by a major surgical intervention or confer consistently good outcomes, regardless of the surgical procedure,” the authors write.

Two authors disclosed financial ties to the pharmaceutical industry.


Reitz KM, Marroquin OC, Zenati MS, et al. Association Between Preoperative Metformin Exposure and Postoperative Outcomes in Adults With Type 2 Diabetes 
[published online April 8, 2020].
JAMA Surg. doi: 10.1001/jamasurg.2020.0416

George EL and Wren SM. Improving Outcomes After Surgery—An Old Medication With Unexpected Benefits [published online April 8, 2020]. JAMA Surg. doi: 10.1001/jamasurg.2020.0417

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