STS: Meds: Anti-Lipids

Pre & Postop Lipid Lowering Agents

A series of STS Definitions:

To Visit the Circuit Surfer STS Page  Click Here

For a list of all STS posts Click Here

If they are here for a heart operation, it’s hard to find a patient who doesn’t have cholesterol and weight issues, has a BMI of less than 24, and isn’t on some sort of anti-lipid therapy.  Typically the most common spectrum of anti-lipid medications fall in the class of Statins.

The first place as usual to find evidence of statin or lipid-lowering  Rx is the H&P.

Empirical evidence in terms of documentation that the patient received this medication within 24 hours of an open heart operation is not as convenient as some of the more serious medications we watch for.

Statins are not on most preperative checklists, as they don’t represent a drug that has significant impact to the operation itself.  It is not vasoactive, fails to impact the coagulation cascade (thereby representing no issue in terms of perioperative hemostasis management), represents no electrolyte balance or endocrine issues, and has thus been relegated to a check mark in lieu of a serious risk or outcomes issues.

Do I worry about Statin verification before I put a patient on bypass?  NO.

So the documentation of statins on the STS form, and the 24 hour verification requirement may represent the “Pandora’s Box”  issue for the perfusionist / data manager.

If I see it on the patient’s chart I mark it as “yes”.  How you decide to approach it is up to you.

Anti-Lipids Defined

Statins (or HMG-CoA reductase inhibitors) are a class of drugs used to lower cholesterol levels by inhibiting the enzyme HMG-CoA reductase, which plays a central role in the production of cholesterol in the liver. Increased cholesterol levels have been associated with cardiovascular diseases (CVD),  and statins are therefore used in the prevention of these diseases. Randomized controlled trials have shown that they are most effective in those already suffering from cardiovascular disease (secondary prevention), but they are also advocated and used extensively in those without previous CVD but with elevated cholesterol levels and other risk factors (such as diabetes and high blood pressure) that increase a person’s risk. Statins have rare but severe adverse effects, particularly muscle damage, and some doctors believe they are overprescribed.

The best-selling of the statins is atorvastatin, marketed as Lipitor and manufactured by Pfizer.

As of 2010, a number of statins are on the market: atorvastatin (Lipitor and Torvast), fluvastatin (Lescol), lovastatin (Mevacor, Altocor, Altoprev), pitavastatin (Livalo, Pitava), pravastatin (Pravachol, Selektine, Lipostat), rosuvastatin (Crestor) and simvastatin (Zocor, Lipex).[5] Several combination preparations of a statin and another agent—such as ezetimibe/simvastatin, sold as Vytorin—are also available.

Source:  Wikkipedia

The STS Standard for Lipid-Lowering Agents:

Indicate whether or not the patient received a lipid lowering medication within 24 hours preceding surgery, or if it was contraindicated or not indicated. The contraindication must be documented in the medical record by a physician, nurse practitioner, or physician assistant.

Preop (STS)

Where to Find

  • Admission assessment
  • History & Physical
  • Medication administration record
  • Physician order sheet
  • Pre-anesthesia record

Indicate Responses For STS

Yes:   Received a lipid-lowering agent within 24 hours preceding surgery

No:      Did not receive a lipid-lowering agent within 24 hours preceding surgery, no reason documented

Contraindicated :  Documented evidence of contraindication: For each medication, check if the medication was not administered or ordered according to data specification timeframe as documented anywhere in the medical record. If a contraindication is documented explicitly as excluded for medical reasons, or is evidenced clearly within the medical record (notation of a medication allergy prior to arrival), check “Contraindication.” Otherwise, do not check “Contraindication.”

List of Lipid Lowering Agents

(Rule of thumb:  If it ends in LOL– it’s probably a Beta Blocker)

Postop (STS)

Where to Find

  • Discharge instruction sheet
  • Discharge summary
  • Medication administration record
  • Physician progress notes
  • Transfer Summary

Indicate Responses For STS

Yes:   Discharged on a lipid-lowering agent at discharge

No:      Not prescribed a lipid-lowering agent at discharge, no reason documented

Contraindicated :  Documented evidence of contraindication:

For each medication, check if the medication was not administered or ordered according to the data specification time frame as documented anywhere in the medical record. If a contraindication is documented explicitly as excluded for medical reasons, or is evidenced clearly within the medical record (notation of a medication allergy prior to arrival), check “Contraindication.”

Otherwise, do not check “Contraindication”.

Statin FAQ (STS)

Q1 :  If it is an elective surgery, the patient is admitted the same day of surgery, can we use the home medications as preoperative medications? If Beta Blocker, Aspirin, lipid lowering meds, etc. are listed as home medications, but they are not taken “today” for the same day of admitted surgery. Which answer would be check, “No” or “Contraindicated/Not indicated”?

Answer:  In order to code the home medications you must have documentation of the date and time the patient received the drug.
In this scenario, the correct coding is “No”.

For all of the available FAQ’s on the STS website:  Click Here

The Ultimate Prize:

Shootin’ for the Stars …

It’s a 3 star system so don’t let that throw you off.

2 stars means you are are great.

3 Stars means you are insanely good at what you do…  and may require medication..

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