title: Preoperative statin therapy decreases risk of postoperative renal insufficiency.
abstract: BACKGROUND
  Although current guidelines recommend withholding statins in perioperative patients, little information is available on whether perioperative statin use increases risk for postoperative renal failure.
  
  
  OBJECTIVE
  We examined the relation between preoperative statin therapy and postoperative risk for renal insufficiency in patients undergoing cardiac surgery.
  
  
  METHODS
  Retrospective cohort review from the Texas Heart Institute research database was performed. Patients were divided into two groups: those who received preoperative statins and those who did not. Primary outcome was the development of postoperative renal insufficiency (requiring dialysis or not). Outcomes were assessed in the entire cohort and in subgroups undergoing isolated coronary artery bypass grafting (CABG), isolated valve surgery, or combined CABG and valve surgery.
  
  
  RESULTS
  Of 3001 patients, 56% received preoperative statins. In multivariate logistic regression analysis, preoperative statins were associated with significant reductions in risk for postoperative renal insufficiency in the entire cohort (odds ratio [OR]= 0.60, 95% confidence interval [CI] 0.38-0.95) and in patients undergoing isolated CABG (OR = 0.34, 95% CI 0.17-0.68). In patients undergoing isolated valve surgery (OR = 1.35, 95% CI 0.61-2.96) or combined CABG and valve surgery (OR = 1.39, 95% CI 0.48-3.99), preoperative statins were not associated with decreased incidence of postoperative renal insufficiency. Age >65 years, preoperative renal insufficiency, history of congestive heart failure, preoperative intra-aortic balloon pump insertion, and total cardiopulmonary bypass time >80 min were also independent predictors associated with increased risk for postoperative renal insufficiency.
  
  
  CONCLUSIONS
  Preoperative statin therapy was associated with decreased incidence of postoperative renal insufficiency in patients undergoing cardiac surgeries, particularly in patients undergoing isolated CABG.
authors.affiliation: Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
authors.forename: Vijay
authors.initials: V
authors.lastname: Nambi
authors.forename: Venkateshwar R
authors.initials: VR
authors.lastname: Polsani
authors.forename: Vei-Vei
authors.initials: VV
authors.lastname: Lee
authors.forename: MacArthur
authors.initials: M
authors.lastname: Elayda
authors.forename: Shun
authors.initials: S
authors.lastname: Kohsaka
authors.forename: Wei
authors.initials: W
authors.lastname: Pan
authors.forename: Ross M
authors.initials: RM
authors.lastname: Reul
authors.forename: James M
authors.initials: JM
authors.lastname: Wilson
authors.forename: Laura A
authors.initials: LA
authors.lastname: Petersen
authors.forename: James T
authors.initials: JT
authors.lastname: Willerson
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects; D005260:Female; D006351:Heart Valves / Q000601:surgery; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019990:Perioperative Care; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors