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Comment & Response
August 12, 2020

Pharmacologic Prehabilitation—What About “the Polypill”?

Author Affiliations
  • 1Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 2Clinical Research, Investigation and Systems Modeling of Acute Illness Center, Pittsburgh, Pennsylvania
  • 3Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
JAMA Surg. 2020;155(11):1083. doi:10.1001/jamasurg.2020.3013

To the Editor We appreciate the interest in and commentary on our published retrospective cohort study1 evaluating the association between preoperative metformin exposure and postoperative outcomes. We agree with George and Wren2 that individual low-risk medications with known adverse events (ie, metformin, statins, and β-blockers) or a combination therapy (ie, the polypill)3 may be the future of perioperative optimization. In our primary analysis, preoperative statin therapy was included in the generation of the propensity score, and statin therapy was well balanced between metformin exposure groups. In sensitivity analysis, statins were considered but not included in the multivariable model owing to both its lack of statistical significance and effect on the hazard of preoperative metformin exposure.

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