Effect of Statins on the Surgical Stress Response in Colorectal Surgery

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dc.contributor.advisor Hill, AG en
dc.contributor.advisor Harrison, J en
dc.contributor.author Singh, Primal en
dc.date.accessioned 2016-08-02T21:20:59Z en
dc.date.issued 2016 en
dc.identifier.citation 2016 en
dc.identifier.uri http://hdl.handle.net/2292/29755 en
dc.description.abstract Major colorectal surgery leads to a significant physiological stress response that is associated with postoperative morbidity and prolonged patient recovery. Statins are a widely used class of cholesterollowering drugs with useful pleiotropic effects that are relevant to abdominal surgery. Despite considerable experimental evidence, the clinical evidence of their benefits in the setting of abdominal surgery is limited to retrospective and observational studies. The aims of this thesis was to examine the correlation of the surgical stress response to postoperative morbidity following major colorectal surgery and explore the novel concept of whether statins can attenuate this response and improve clinical outcomes after surgery. Chapter one discusses the basis of the surgical stress response, introduces the concept of statins and presents the evidence demonstrating their surgically relevant benefits. Chapter two explores the association between postoperative inflammation and morbidity after colorectal surgery by presenting a meta-analysis which shows C-reactive protein levels in the early postoperative period correlate with the development of anastomotic leakage and have a useful negative predictive value. Chapter three presents a retrospective study which demonstrates the relationship between patient-reported functional recovery and morbidity following colonic surgery using the surgical recovery score questionnaire and shows it closely correlates with postoperative complications and their severity. In chapter four, a retrospective review of patients undergoing elective colectomy is presented and shows patients on statins during the perioperative period achieved equivalent outcomes for complications and functional recovery despite significantly higher perioperative risk and had a significantly lower rate of anastomotic leak. Chapter five is a systematic review which critically appraises the available clinical studies on the use of statins in abdominal surgery and shows the various benefits demonstrated, particularly for inflammatory and infective outcomes. This leads to a placebo-controlled, randomised clinical trial presented in chapter six which shows that perioperative oral simvastatin therapy in patients undergoing major elective colorectal surgery leads to a significant reduction in inflammatory markers in the early postoperative period but no difference in complications or functional recovery. Therefore, the addition of perioperative simvastatin therapy cannot be recommended as a routine for patients undergoing major elective colorectal surgery. en
dc.publisher ResearchSpace@Auckland en
dc.relation.ispartof PhD Thesis - University of Auckland en
dc.relation.isreferencedby UoA99264870381102091 en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/3.0/nz/ en
dc.title Effect of Statins on the Surgical Stress Response in Colorectal Surgery en
dc.type Thesis en
thesis.degree.discipline Surgery en
thesis.degree.grantor The University of Auckland en
thesis.degree.level Doctoral en
thesis.degree.name PhD en
dc.rights.holder Copyright: The Author en
dc.rights.accessrights http://purl.org/eprint/accessRights/OpenAccess en
pubs.elements-id 537558 en
pubs.record-created-at-source-date 2016-08-03 en

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