Preoperative use of statins is associated with reduced early delirium rates after cardiac surgery.
BACKGROUND
Delirium is an acute deterioration of brain function characterized by fluctuating consciousness and an inability to maintain attention. Use of statins has been shown to decrease morbidity and mortality after major surgical procedures. The objective of this study was to determine an association between preoperative administration of statins and postoperative delirium in a large prospective cohort of patients undergoing cardiac surgery with cardiopulmonary bypass.


METHODS
After Institutional Review Board approval, data were prospectively collected on consecutive patients undergoing cardiac surgery with cardiopulmonary bypass from April 2005 to June 2006 in an academic hospital. All patients were screened for delirium during their hospitalization using the Confusion Assessment Method in the intensive care unit. Multivariable logistic regression analysis was used to identify independent perioperative predictors of delirium after cardiac surgery. Statins were tested for a potential protective effect.


RESULTS
Of the 1,059 patients analyzed, 122 patients (11.5%) had delirium at any time during their cardiovascular intensive care unit stay. Administration of statins had a protective effect, reducing the odds of delirium by 46%. Independent predictors of postoperative delirium included older age, preoperative depression, preoperative renal dysfunction, complex cardiac surgery, perioperative intraaortic balloon pump support, and massive blood transfusion. The model was reliable (Hosmer-Lemeshow test, P = 0.3) and discriminative (area under receiver operating characteristic curve = 0.77).


CONCLUSIONS
Preoperative administration of statins is associated with the reduced risk of postoperative delirium after cardiac surgery with cardiopulmonary bypass.
Katznelson
Rita
R
Dpartment of Anesthesia, Toronto General Hospital, University of Toronto, Toronto, Canada. rita.katznelson@uhn.on.ca
Djaiani
George N
GN
Borger
Michael A
MA
Friedman
Zeev
Z
Abbey
Susan E
SE
Fedorko
Ludwik
L
Karski
Jacek
J
Mitsakakis
Nicholas
N
Carroll
Jo
J
Beattie
W Scott
WS
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D015331:Cohort Studies; D003693:Delirium / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D013997:Time Factors
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors