Background The influence of red yeast rice (RYR) on perioperative outcome remains unknown. Aim We aimed to compare the complications and mortality after surgery between patients treated with and without RYR prescription. Design In this surgical cohort study of 3.6 million surgical patients who underwent major inpatient surgeries, 2581 patients who used RYR prescription pre-operatively were compared with 25 810 non-RYR patients selected by matching for age and sex. Methods Patients' demographics and medical conditions were collected from the claims data of the National Health Insurance in Taiwan. Complications and mortality after major surgeries in association with RYR prescription were investigated by calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs) by multiple logistic regression. Results Compared with patients without RYR prescription, patients prescribed RYR had lower risks of post-operative bleeding (OR 0.36, 95% CI 0.15-0.89), pneumonia (OR 0.54, 95% CI 0.36-0.83), stroke (OR 0.66, 95% CI 0.47-0.92) and 30-day in-hospital mortality (OR 0.37, 95% CI 0.15-0.92). Decreased risk of intensive care (OR 0.64, 95% CI 0.54-0.77), shorter length of hospital stay (P < 0.001) and lower medical expenditures (P = 0.0008) during the index surgical admission were also noted for patients with RYR prescription compared to those for patients without RYR prescription. Conclusions This study showed a potentially positive effect of RYR on outcomes after major surgeries. However, patient non-compliance for taking medication should be noted. Our findings require future prospective studies to validate RYR prescription for improving perioperative outcomes.
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