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Original Articles: Adult Cardiac

Preoperative Statin Therapy Is Not Associated With a Decrease in the Incidence of Delirium After Cardiac Operations

^a Department of Surgical and Morphological Sciences, Cardiac Surgery Unit, Varese University Hospital, University of Insubria, Varese, Italy
^b Department of Cardiovascular Sciences, Cardiac Surgery, and Intensive Care Unit, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, University of Milan, Milan, Italy
^c Department of Hypertension, Medical University of Lodz, Lodz, Poland
^d Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
^e Department of Surgical and Morphological Sciences, Vascular Surgery Unit, Varese University Hospital, University of Insubria, Varese, Italy
^f Cardiac Intensive Care Unit, Cardiac Surgery Unit, Varese University Hospital, University of Insubria, Varese, Italy

Accepted for publication February 6, 2012.

^_* Address correspondence to Dr Mariscalco, Department of Surgical Sciences, Cardiac Surgery Unit, Varese University Hospital, University of Insubria, Via Guicciardini 9, 21100 Varese, Italy (Email: giovannimariscalco{at}yahoo.it).

Background: Delirium after cardiac operations is associated with significant morbidity and death. Statins have been recently suggested to exert protective cerebral effects. This study investigated whether preoperative statins were associated with decreased incidence of postoperative delirium in patients undergoing coronary artery bypass grafting.

Methods: The study enrolled 4,659 consecutive patients (21% women; age, 67.8 ± 9.2 years) undergoing coronary artery bypass grafting. A propensity score-based optimal-matching algorithm was used to match 1,577 patients receiving preoperative statins with a control group (1:1). Patients were screened for delirium in the intensive care unit according to the Confusion Assessment Method for the intensive care unit.

Results: Delirium affected 89 patients (3%), and preoperative statin administration was not multivariably associated with a decreased incidence of delirium (odds ratio, 1.52; 95% confidence interval, 0.97 to 2.37; p = 0.18) and was also unrelated to a delirium decrease in patient subgroups undergoing isolated coronary artery bypass grafting (odds ratio, 1.31; 95% confidence interval, 0.68 to 2.52; p = 0.51) or combined valvular procedures (odds ratio, 1.72; 95% confidence interval, 0.96 to 3.07, p = 0.08). Similar results were observed for age groups and cardiopulmonary bypass durations. Patients affected by postoperative delirium experienced a longer hospital stay (25th to 75th percentile) of 11 (7 to 18 days) vs 7 days (7 to 8 days, p < 0.001) and 12% hospital mortality vs 1% (p < 0.001).

Conclusions: Preoperative statins were not associated with a decreased incidence of delirium in patients undergoing coronary revascularization.

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Invited Commentary

Simon Mitchell
Ann. Thorac. Surg. 2012 93: 1447-1448. [Extract] [Full Text] [PDF]

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				S. Mitchell Invited Commentary Ann. Thorac. Surg., May 1, 2012; 93(5): 1447 - 1448. [Full Text] [PDF]