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Invited Commentary
April 8, 2020

Improving Outcomes After Surgery—An Old Medication With Unexpected Benefits

Author Affiliations
  • 1Department of Surgery, Stanford University School of Medicine, Stanford, California
JAMA Surg. Published online April 8, 2020. doi:10.1001/jamasurg.2020.0417

In this issue of JAMA Surgery, Reitz et al1 report that metformin prescription status was associated with improved 90-day survival and fewer readmissions in a propensity-matched cohort study of more than 5000 patients with diabetes who underwent a major operation in a multicenter, single health care system over a 5-year period. The study results show that preoperative metformin use was associated with lower adjusted hazard ratios of postoperative mortality and readmission. This study demonstrates how variables besides coexisting medical diseases can affect surgical outcomes. Metformin now joins β-blockers, statins, and immunonutrition as preoperative agents associated with improved surgical outcomes. It may be only a matter of time before optimization of postoperative outcomes with perioperative medications and supplements becomes a standard. To answer this question more completely, further analysis or future trials should factor in statin use, as well as whether medications are continued in the postoperative period.

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