PREOPERATIVE STATINS REDUCE POSTOPERATIVE DELIRIUM FOLLOWING OFF PUMP CORONARY ARTERY BYPASS

Abstract

The delirium is a common adverse event following cardiac surgery. Statins have an anti-inflammatory effect that can mitigate the postoperative neuro-inflammation. However, the role of statins in preventing postoperative delirium remains controversial. The aim of this study was the assess the impact of preoperative statin intake on postoperative delirium in patients undergoing off pump coronary artery bypass (OPCAB). From 1996 to 2007, 1400 patients underwent OPCAB surgery in our center. Patients were prospectively followed and data collected in a dedicated database. The mean age was 65 ± 1 years (21% female) and mean follow-up was 5.2 ± 0.1 years. Statins were taken by 615 (44%) patients preoperatively (the statin group). A propensity score was performed to match the statin group patients with the no-statin group (1:1) and resulted in 304 pairs. In the matched cohort, there was no difference in baseline characteristics between the two groups. The primary endpoint was the incidence of delirium. Secondary outcomes were the predictors of delirium and the impact of postoperative delirium on early and long-term mortality. Multivariable regressions were performed for the variables associated with postoperative delirium, early and late mortality in the unmatched cohort. Overall, the incidence of delirium was 12%. In the matched cohort, the postoperative delirium was significantly reduced in the statin group (10 vs 16%, p=0.03). In multivariable analysis, preoperative statin (OR: 0.62 [0.41-0.95], p=0.03), age (OR: 1.02 [1.00-1.04], p=0.05), ventilation time (OR:1.02 [1.01-1.03]) and postoperative transfusion (OR: 1.55 [1.00-2.42], p=0.05) were associated with postoperative delirium. The postoperative delirium was not associated with early and long-term mortality (p=0.47 and p=0.53). Preoperative statins reduce postoperative delirium following OPCAB surgery. In our study, postoperative delirium did not affect early and long-term mortality following OPCAB. Further randomized studies are needed to confirm these resutls.