Perioperative Statin Research Articles

Propensity-matched analysis of the influence of perioperative statin therapy on outcomes after liver resection.

BackgroundPerioperative use of statins is reported to improve postoperative outcomes after cardiac and non‐cardiovascular surgery. The aim of this study was to investigate the influence of statins on postoperative outcomes including complications of grade IIIa and above, posthepatectomy liver failure (PHLF), and 90‐day mortality rates after liver resection.MethodsPatients who underwent hepatectomy between 2013 and 2017 were reviewed to identify statin users and non‐users (controls). Propensity matching was conducted for age, BMI, type of surgery and preoperative co‐morbidities to compare subgroups. Univariable and multivariable analyses were performed for the following outcomes: 90‐day mortality, significant postoperative complications and PHLF.ResultsOf 890 patients who had liver resection during the study period, 162 (18·2 per cent) were taking perioperative statins. Propensity analysis selected two matched groups, each comprising 154 patients. Overall, 81 patients (9·1 per cent) developed complications of grade IIIa or above, and the 90‐day mortality rate was 3·4 per cent (30 patients), with no statistically significant difference when the groups were compared before and after matching. The rate of PHLF was significantly lower in patients on perioperative statins than in those not taking statins (10·5 versus 17·3 per cent respectively; P = 0·033); similar results were found after propensity matching (10·4 versus 20·8 per cent respectively; P = 0·026).ConclusionThe rate of PHLF was significantly lower in patients taking perioperative statins, but there was no statistically significant difference in severe complications and mortality rates.

Association between perioperative statin use and postoperative pain after total knee arthroplasty

Background and objectivesData is insufficient to determine whether perioperative statin use increases or decreases postoperative pain. This study aimed to investigate the association between perioperative statin use and pain outcomes...

Prevention of post-operative complications by using a HMG-CoA reductase inhibitor in patients undergoing one-lung ventilation for non-cardiac surgery: study protocol for a randomised controlled trial

BackgroundPostoperative pulmonary complications (PPC) and peri-operative myocardial infarction (MI) have a significant impact on the long-term mortality of surgical patients. Patients undergoing one-lung ventilation (OLV) for surgery are at a high risk of developing these complications. These complications could be associated with intensive care unit (ICU) admissions and longer hospital stay with associated resource and economic burden. Simvastatin, a HMG-CoA reductase enzyme inhibitor has been shown to have pleiotropic anti-inflammatory effects as well as being endothelial protective. The benefits of statins have been shown in various observational studies and in small proof-of-concept studies. There is an urgent need for a well-designed, large clinical trial powered to detect clinical outcomes. The Prevention HARP 2 trial will test the hypothesis ‘simvastatin 80 mg when compared to placebo will reduce cardiac and pulmonary complications in patients undergoing elective oesophagectomy, lobectomy or pneumonectomy’.Methods/designThe Prevention HARP 2 trial is a UK multi-centre, randomised, double-blind, placebo-controlled trial. Adult patients undergoing elective oesophagectomy, lobectomy or pneumonectomy will be eligible. Patients who are already on statins will be excluded from this trial. Patients will be randomised to receive simvastatin 80 mg or matched placebo for 4 days pre surgery and for up to 7 days post surgery. The primary outcome is a composite outcome of PPC and MI within 7 days post surgery. Various secondary outcome measures including clinical outcomes, safety outcomes and health economic outcomes will be collected. The study aims to recruit 452 patients in total across 12 UK sites.DiscussionThe results of the Prevention HARP 2 trial should add to our understanding of the benefits of peri-operative statins and influence clinical decision-making. Analysis of blood and urine samples from the patients will provide insight into the mechanism of simvastatin action.Trial registrationInternational Standard Randomised Controlled Trials registry, ID: ISRCTN48095567. Registered on 11 November 2016.

Statin intensity and postoperative mortality following open repair of intact abdominal aortic aneurysm.

BackgroundThere is a lack of evidence for the association between intensive statin therapy and outcomes following vascular surgery. The aim of this study was to evaluate the association between perioperative statin intensity and in‐hospital mortality following open abdominal aortic aneurysm (AAA) repair.MethodsPatients undergoing open AAA repair between 2009 and 2015 were identified from the Premier Healthcare Database. Statin use was classified into low, moderate and high intensity, based on American College of Cardiology/American Heart Association guidelines. Supratherapeutic intensity was defined as doses higher than the recommended guidelines. Multivariable logistic regression analyses were undertaken to assess the association between statin intensity and postoperative major adverse events and in‐hospital mortality.ResultsOf 6497 patients undergoing open AAA repair, 3217 (49·5 per cent) received perioperative statin. Statin users were more likely to present with three or more co‐morbidities than non‐users (26·5 versus 21·8 per cent; P < 0·001). Unadjusted postoperative mortality was significantly lower in statin users (2·6 versus 6·3 per cent; P < 0·001); however, there was no difference in the risk of developing major adverse events. Multivariable analysis showed that statin use was associated with lower odds of death (odds ratio 0·41, 95 per cent c.i. 0·31 to 0·54). Moderate, high and supratherapeutic statin intensities were not associated with lower odds of death or major adverse events compared with low‐intensity statin therapy.ConclusionStatin use is associated with lower odds of death in hospital following open AAA repair. High‐intensity statins were not associated with lower morbidity or mortality.

The Role of Perioperative Statin Use in the Prevention of Delirium After Total Knee Replacement Under Spinal Anesthesia

BackgroundThe relationship between statin use and incidence of postoperative delirium (POD) is controversial. We investigated the association between perioperative statin use and occurrence of delirium after total knee arthroplasty (TKA) under spinal anesthesia. MethodsWe retrospectively reviewed the electronic medical records of patients who underwent TKA under spinal anesthesia at a single tertiary care hospital between January 2005 and October 2017. POD incidence was recorded for patients who received statins continuously from 1 month before surgery until discharge and for patients who did not receive any statins. Univariable and multivariable logistic regression analyses were conducted to investigate an association between occurrence of POD and perioperative statin use. ResultsIn total, 6020 procedures were included, and 992 (16.4%) were associated with perioperative statin use. POD was confirmed for 304 (5.0%) procedures. The statin group showed a 1.7% significant lower incidence (P = .017) of POD (35/992, 3.5%) than the no statin group (1420/5,028, 5.4%). In multivariable logistic regression analysis, the POD incidence in the statin group was 34% lower than that in the no statin group (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.45-0.97, P = .036]. Moreover, the POD incidence was decreased by 37% (OR 0.63, 95% CI 0.40-0.99, P = .047) and 79% (OR 0.21, 95% CI 0.05-0.88, P = .033) respectively, when atorvastatin and simvastatin were administered. ConclusionContinuous perioperative statin use may be associated with a significantly lower risk of delirium after TKA under spinal anesthesia; simvastatin was the most effective statin for POD prevention.

Perioperative statins prevent early complications of the surgical revascularization in patients with stable coronary artery disease

Perioperative statins prevent early complications of the surgical revascularization in patients with stable coronary artery disease

Effects of perioperative statins on patient outcomes after noncardiac surgery: a meta-analysis

Background: Cardiovascular complications are strongly correlated with a higher risk of mortality during follow-up after noncardiac surgery. However, controversy remains regarding whether perioperative administration of hydroxymethylglutaryl-CoA reductase inhibitors (statins) has a beneficial effect on patient outcomes.Objective: We performed a meta-analysis to validate the hypothesis that perioperative statins improve patient outcomes after noncardiac surgery.Methods: Electronic databases (PubMed, Web of Science, EMBASE, and the Cochrane Library) were searched for randomized controlled trials (RCTs) published up to 10 November 2017. RCTs were eligible for inclusion if they compared perioperative statin treatment with control treatment in patients scheduled for noncardiac surgery and reported data pertaining to clinical outcomes.Results: Twelve RCTs involving 4707 patients (2371 in the perioperative statin group and 2336 in the control group) were ultimately included in this meta-analysis. The incidences of postoperative myocardial infarction, composite of death/myocardial infarction/stroke and new cases of atrial fibrillation were all lower in patients treated with statins than in control group patients, as shown by the fixed-effects model (odds ratio (OR) = 0.460, 95% confidence interval (CI) = 0.324–0.653, p = 0 for myocardial infarction; OR = 0.617, 95% CI = 0.476–0.801, p = 0 for composite of death/myocardial infarction/stroke; OR = 0.406, 95% CI = 0.247–0.666, p = 0 for new atrial fibrillation). No significant differences in the incidences of stroke or transient ischemic attack, all-cause mortality and cardiovascular mortality were observed between the statin and control arms.Conclusions: This meta-analysis supports the hypothesis that perioperative statins effectively reduce the incidences of postoperative myocardial infarction, composite of death/myocardial infarction/stroke and new cases of atrial fibrillation in patients undergoing noncardiac surgery.Key MessagesCardiovascular complications are strongly correlated with a higher risk of mortality during follow-up after noncardiac surgery.We performed a meta-analysis to confirm the hypothesis that perioperative statins improve patient outcomes after noncardiac surgery.

Perioperative Statin Use and Acute Kidney Injury in Patients Undergoing Partial Nephrectomy.

Background:Statin use is widespread among the general population. Data suggest a potentially beneficial effect of statin therapy on renal function following surgery. The impact of statins on post-partial nephrectomy (PN) renal function is unknown. We hypothesized that perioperative statin use may be associated with reduced rates of acute kidney injury (AKI) in patients undergoing PN.Objectives:To evaluate the effect of perioperative statin use on AKI rates in patients undergoing PN.Materials & Methods:1,056 patients undergoing PN were identified from a prospectively-maintained institutional renal mass database. Exclusion criteria included lack of preoperative serum creatinine (Cr), concurrent surgeries, and those with baseline Cr <0.4. The binary outcome was AKI, defined using modified Kidney Disease Improving Global Outcomes (KDIGO) criteria. Chi-Square and Cochran-Armitage trend tests were used to evaluate the strength of associations. A multivariate logistic regression model was used to determine predictors of AKI.Results:Statin use was reported by n = 346 (32.8%) patients at the time of surgery. Univariate analysis demonstrated that statin use was associated with an increased risk of AKI following PN (OR 1.38, CI 1.01–1.88, p = 0.04). On multivariate analysis, statin use was no longer associated with AKI following PN (OR 1.09, CI 0.76–1.56, p = 0.65). Gender, BMI, comorbidity index, hypertension, surgical approach, ischemia temperature/time, and nephrometry “R” score were all independently associated with AKI.Conclusions:Perioperative statin use at the time of PN was not associated with rates of post-operative AKI. Prospective studies are needed to elucidate the effects of statins on functional outcomes following PN.

Statin therapy is associated with higher long-term but not perioperative survival after abdominal aortic aneurysm repair

BackgroundAlthough preoperative and perioperative statin therapy improves postoperative outcomes in several populations, few data examine its association with survival after abdominal aortic aneurysm (AAA) repair. In addition, no data exist regarding the benefits of starting statins in patients with AAA not currently taking them. MethodsWe performed a registry-based study of all patients undergoing repair of AAAs in the Vascular Quality Initiative between 2003 and 2017 without documented statin intolerance. In our primary analysis, we evaluated the association between preoperative statin therapy and long-term mortality, 30-day mortality, and in-hospital myocardial infarction and stroke. As a secondary analysis, we studied the cohort of patients not taking a statin preoperatively and compared their long-term mortality on the basis of whether they were discharged on a statin. To account for nonrandom assignment to treatment, we constructed propensity scores and applied inverse probability weighting. ResultsWe identified 40,452 AAA repairs, of which 37,950 fit our entry criteria (29,257 endovascular and 8693 open). Overall, 25,997 patients (69%) were taking a statin preoperatively, with patients undergoing endovascular aneurysm repair more frequently taking a statin than those undergoing open repair (69% compared with 66%; P < .001). After propensity weighting, preoperative statin therapy was not associated with 30-day death or in-hospital stroke or myocardial infarction. However, patients taking statins preoperatively experienced higher adjusted 1-year (94% vs 90%) and 5-year (85% vs 81%) survival from the date of surgery compared with those who were not (P < .001 overall), although subgroup analysis showed that this applied only to intact or symptomatic aneurysms. Of the 11,941 patients not taking a statin preoperatively and discharged alive, 2910 (24%) started on a statin before discharge. In our secondary analysis of the subset of patients not taking statins preoperatively, those initiated on a statin before discharge experienced higher survival at 1 year (94% vs 91%) and 5 years (89% vs 81%; P < .001 overall) than those who remained off statin therapy, with the greatest absolute long-term survival difference in patients with rupture (87% vs 62%; P < .001 overall). ConclusionsPreoperative statin therapy is associated with higher long-term survival but not perioperative mortality and morbidity in patients undergoing AAA repair, and initiating statin therapy in previously statin-naive patients is associated with markedly higher survival. All patients with AAAs without contraindications should receive statin therapy. In patients not taking a statin at the time of AAA repair, clinicians should consider initiating one before discharge.

Role of statins in preventing cardiac surgery-associated acute kidney injury: an updated meta-analysis of randomized controlled trials.

BackgroundThe prevention of cardiac surgery-associated acute kidney injury (CSA-AKI) by statins remains controversial. Therefore, the present meta-analysis including randomized controlled trials (RCTs) was performed to assess the effect of perioperative statin on CSA-AKI.MethodsTwo reviewers independently searched for RCTs about perioperative statin for prevention of CSA-AKI. The primary endpoint was CSA-AKI. Relative risk was calculated between statin and placebo for preventing CSA-AKI using the random-effect model or fixed-effect model according to different heterogeneity.ResultsEight RCTs met inclusion criteria, including five studies with atorvastatin, two with rosuvastatin, and one with simvastatin. There were 1,603 patients receiving statin treatment and 1,601 with placebo. Perioperative statin therapy did not reduce the incidence of CSA-AKI (relative risk =1.17, 95% CI: 0.98–1.39, p=0.076). Furthermore, perioperative statin increased the risk of CSA-AKI in the subgroup analysis with clear definition of CSA-AKI and those with JADAD score >3. Perioperative rosuvastatin produced slightly significantly higher risk of AKI than atorvastatin therapy (p=0.070). Statin intervention both pre and post surgery slightly increased the risk of CSA-AKI versus preoperative statin therapy alone (p=0.040).ConclusionsPerioperative statin therapy might increase the risk of CSA-AKI after cardiac surgery.

High-Density Lipoprotein Cholesterol Concentration and Acute Kidney Injury After Cardiac Surgery.

BackgroundAcute kidney injury (AKI) after cardiac surgery is associated with increased short‐ and long‐term mortality. Inflammation, oxidative stress, and endothelial dysfunction and damage play important roles in the development of AKI. High‐density lipoproteins (HDLs) have anti‐inflammatory and antioxidant properties and improve endothelial function and repair. Statins enhance HDL's anti‐inflammatory and antioxidant capacities. We hypothesized that a higher preoperative HDL cholesterol concentration is associated with decreased AKI after cardiac surgery and that perioperative statin exposure potentiates this association.Methods and ResultsWe tested our hypothesis in 391 subjects from a randomized clinical trial of perioperative atorvastatin to reduce AKI after cardiac surgery. A 2‐component latent variable mixture model was used to assess the association between preoperative HDL cholesterol concentration and postoperative change in serum creatinine, adjusted for known AKI risk factors and suspected confounders. Interaction terms were used to examine the effects of preoperative statin use, preoperative statin dose, and perioperative atorvastatin treatment on the association between preoperative HDL and AKI. A higher preoperative HDL cholesterol concentration was independently associated with a decreased postoperative serum creatinine change (P=0.02). The association between a high HDL concentration and an attenuated increase in serum creatinine was strongest in long‐term statin‐using patients (P=0.008) and was further enhanced with perioperative atorvastatin treatment (P=0.004) and increasing long‐term statin dose (P=0.003).ConclusionsA higher preoperative HDL cholesterol concentration was associated with decreased AKI after cardiac surgery. Preoperative and perioperative statin treatment enhanced this association, demonstrating that pharmacological potentiation is possible during the perioperative period.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique Identifier: NCT00791648.

Early outcomes of perioperative statin therapy for elderly patients undergoing off-pump coronary artery bypass surgery: a propensity score-matched study

BackgroundFew studies have investigated the efficacy and safety of perioperative continuation of statin therapy in individuals who undergo off-pump coronary artery bypass surgery (OPCAB). This study aims to evaluate the efficacy of perioperative continuation of statin therapy on early graft patency and clinical outcomes among elderly patients who underwent OPCAB. MethodsA total of 330 consecutive elderly patients (age >60 years) who underwent OPCAB in a single-institution database (Oct 1, 2009, to Sept 30, 2012) were stratified by perioperative continuation of statin administration. To account for baseline differences, patients were propensity matched by inverse probability weighting across 20 preoperative and procedural characteristics, resulting in a well matched cohort. The primary outcomes were perioperative graft patency at an average of 5 days after operation, as assessed by independent blinded observers documented by multislice CT angiography, and in-hospital mortality. Secondary outcomes included duration of stay in the intensive care unit, blood biomarkers, left ventricular function, and liver and renal function. All statistical analyses were performed using SAS for Windows version 9.1. FindingsThere was no in-hospital death in this study. LDL concentration was significantly lower in those who continued statin therapy than in those who discontinued (64·24 mg/dL vs 77·05 mg/dL, p<0·0001). Total cholesterol concentration was also lower within the continued statin group (126·47 mg/dL vs 138·14 mg/dL, p<0·0001). Perioperative graft patency did not differ significantly between the continued statin group (237 patients, 98%) and the discontinued statin group (93 patients, 97%; p=0·6). Secondary outcomes showed no significant difference in serum creatinine (1·08 mg/dL vs 1·09 mg/dL, p=0·9) and estimated glomerular filtration rate (69·19 mL/min per 1·73m2vs 69·63 mL/min per 1·73m2, p=0·8). However, abnormal elevation of alanine transaminase was observed in 237 (8%) patients within the continued statin group and in 93 (2%) patients within the discontinued statin group (p=0·001). InterpretationAmong elderly patients undergoing OPCAB, the continued administration of perioperative statin therapy did not improve early graft patency. Perioperative continuation of statin use tended to increase the risk of abnormal liver function. There is insufficient evidence to recommend perioperative continuation of statin therapy for OPCAB. FundingNo funding.

Impact of statin use on the prognosis of patients with hepatocellular carcinoma undergoing liver resection: a subgroup analysis of patients without chronic hepatitis viral infection

BackgroundStatins have been reported to reduce the risk of hepatocellular carcinoma (HCC). The effect of perioperative statin use on the prognosis of HCC patients undergoing liver resection remains unclear. MethodsWe retrospectively analyzed 643 patients who underwent curative liver resection for HCC. Patients negative for hepatitis B surface antigen and hepatitis C antibody were classified as the non-B non-C HCC subgroup (n = 204). Perioperative statin users were defined as patients preoperatively receiving statin medications and maintaining > 28 cumulative defined daily doses after liver resection. The recurrence-free survival (RFS) and overall survival (OS) according to statin use were analyzed in the overall HCC cohort or in the non-B non-C HCC subgroup. ResultsAmong a total of 643 (HCC) patients, 43 patients (6.7%) received perioperative statin medications. In statin users, the proportion of non-B non-C HCC patients was significantly higher than in nonstatin users. Statin users had a high prevalence of obesity and diabetes, as well as dyslipidemia. The liver function of statin users was better than that of nonstatin users. The multivariate survival analysis revealed that use of statins was significantly associated with improvement of RFS (hazard ratio [HR], .42; 95% confidence interval [CI], 0.25–0.71; P = .001), but not with OS (HR, 0.62; 95% CI, 0.30–1.27; P = .19). In the subgroup analysis of the non-B non-C HCC cohort, statin use was significantly associated with improvement of RFS (HR, 0.47; 95% CI, 0.22–0.99; P = .04). ConclusionPerioperative statin use was associated with an improvement of RFS in HCC patients undergoing curative liver resection.

Perioperative statin administration with decreased risk of postoperative atrial fibrillation, but not acute kidney injury or myocardial infarction: A meta-analysis

A controversy effect of perioperative statin use for preventing postoperative atrial fibrillation (POAF) and acute kidney injury (AKI) after cardiac surgery still remains. We thus performed current systematic review and meta-analysis to comprehensively evaluate effects of statin in cardiac surgery. 22 RCTs involving 5243 patients were included. Meta-analysis of 18 randomized controlled trials with 3995 participants suggested that perioperative statin use could decrease the risk of POAF (relative risk [RR] 0.69, 95%CI 0.56 to 0.86, P = 0.001), with a moderate heterogeneity (I2 = 65.7%, PH < 0.001). And the beneficial effect was found only in patients receiving coronary artery bypass graft (CABG), but not in patients undergoing valve surgery. However, perioperative statin use was not associated with lower risks of AKI (RR 0.98, 95%CI 0.70 to 1.35, P = 0.884, I2 = 33.9%, PH = 0.157) or myocardial infarction (MI) (RR 0.84, 95%CI 0.58 to 1.23, P = 0.380, I2 = 0%, PH = 0.765), and even an increased trend of AKI was observed in patients with valve surgery. Perioperative statin use could decrease the inflammation response with no impact on clinical outcomes. In conclusion, perioperative statin use is useful in preventing POAF, particularly in patients with CABG, and ameliorate inflammation, while it has no effect on AKI and MI after cardiac surgery.

Effects of perioperative statin use on cardiovascular complications in patients submitted to non-cardiac surgery: protocol for a systematic review, meta-analysis, and trial sequential analysis

BackgroundPreliminary evidence suggests statins may reduce major perioperative vascular events. However, evidence is limited to observational studies, underpowered trials, and non-comprehensive systematic reviews. This review aims to assess the effects of perioperative statin use on cardiovascular complications in patients submitted to non-cardiac surgery.MethodsWe will search MEDLINE/PubMed, EMBASE, LILACS, CENTRAL, Web of Science, and CINAHL for randomized controlled trials assessing the effects of perioperative statin use in adults undergoing non-cardiac surgery and reporting cardiovascular complications. For patients already using statins for hyperlipidemia, a preoperative loading dose of statin is required in the experimental group. We will place no language or publication restriction on our search. Teams of two reviewers will independently assess eligibility and risk of bias, and will extract data from the included trials. Our primary outcome is a combination of cardiovascular mortality or non-fatal myocardial infarction. We will also assess the following outcomes: individual components of the primary outcome, all-cause mortality, total myocardial infarction, elevated troponin in the first seven postoperative days, total stroke, total venous thromboembolism, postoperative atrial fibrillation, elevation of creatine phosphokinase or liver enzymes, and rates of myalgia or rhabdomyolysis. We will conduct meta-analyses using random-effects model and will use trial sequential analysis to establish monitoring boundaries to limit global type I error due to repetitive testing for our primary outcome. We will rate the quality of evidence using the GRADE system.DiscussionThe results of this systematic review may help to inform clinical practice and also the design of future large-scale randomized trials.Systematic review registrationPROSPERO CRD42016035987

Perioperative beta blockers and statins for noncardiac surgery patients with coronary stents

ImportanceRecent publications report that perioperative initiation of statin therapy is associated with improved outcomes particularly among patients with increased cardiac risk. However, findings on associations with beta blocker (BB) initiation are mixed. ObjectiveThis study examines associations between perioperative statin and BB use in a national sample of patients with cardiac stents. DesignRetrospective cohort study. SettingVA Medical Centers nationwide. ParticipantsWe identified Veterans Affairs (VA) patients undergoing non-cardiac surgery in the within two years after stent placement between October 2002 and September 2011 with BB and/or statin prescriptions within one year prior to surgery. Using VA inpatient data we identified major adverse cardiac or cerebrovascular events (MACCE) within 30 days of surgery. General usage patterns and percent of days covered by medication were calculated as additional markers of medication use. Adjusted logistic regression was used to examine associations between medication use and 30-day postoperative outcomes. Results23,537 patients underwent surgery within 2 years following stent placement, of whom 20,566 (88.6%) had prescriptions for beta blockers and statins within 365 days prior to surgery. Of those, 13,501 (65.6%) used both BB and statins prior to surgery, while 2626 (12.8%) used only BB, 2346 (11.4%) used only statins, and 2093 (10.2%) used neither. In fully adjusted models, the only significant association was between perioperative statin use and decreased mortality (OR 0.65, 95% CI 0.48–0.87). ConclusionsOur results suggest that maintaining statin therapy perioperatively is associated with reduced 30 day mortality in stented patients undergoing non-cardiac surgery who have previously been prescribed both beta blockers and statins.

Perioperative statin use is associated with decreased incidence of primary graft dysfunction after lung transplantation

Primary graft dysfunction (PGD) is a major cause of early morbidity and mortality after lung transplantation. Statins reduce the risk of chronic rejection after lung transplantation, but their effects on PGD are unknown. We hypothesized that perioperative statin therapy decreases the risk for PGD after lung transplantation. We retrospectively reviewed records of all patients undergoing lung transplantation between January 1999 and December 2014 at the University of Virginia Health System. The primary outcome was PGD (grades 1-3). Secondary outcomes included grade 3 PGD, length of intensive care unit and hospital stay, and mortality. Of 266 patients who met final inclusion criteria, 138 (52%) were diagnosed with PGD. In-hospital mortality among patients with PGD was 6.5%. There were no deaths in patients without PGD (p < 0.001). PGD was diagnosed in 24 patients taking statins (34.8%) and in 114 patients (57.9%) who did not take statins (p = 0.001). After propensity score adjustments, perioperative statin use was independently associated with a reduced risk for PGD (odds ratio [OR] 0.41, 95% confidence interval [CI] 0.20-0.84, p = 0.015) and reduced risk to develop grade 3 PGD (OR 0.42, 95% CI 0.18-0.94, p = 0.036). Other risk factors associated with PGD included intraoperative use of cardiopulmonary bypass (OR 3.74, 95% CI 1.75-8.02, p = 0.001) and positive donor smoking status (OR 2.27, 95% CI 1.18-4.35, p = 0.014). The results demonstrate that perioperative use of statins is independently associated with reduced risk for PGD after lung transplantation.

Effect of perioperative statin therapy on renal outcome in patients undergoing cardiac surgery: A meta-analysis of randomized controlled trials.

Acute renal injury (AKI) is a common renal complication after cardiac surgery. The aim of this study was to determine the effect of perioperative statin therapy (PST) on postoperative renal outcome in patients undergoing cardiac procedures. We searched for the reports that evaluating the effect of PST on renal outcomes after cardiac surgery between March 1983 and June 2016 in the electronic database Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE/PubMed, and EMBASE/OVID. Nine randomized controlled trials (RCTs) enrolling 2832 patients, with 1419 in the PST group and 1413 in the control group, were included in this meta-analysis. Our results suggested that PST increased the incidence of postoperative renal complication (relative risk [RR] 1.18, 95% confidence interval [CI] 1.01-1.36, P = .03) with low heterogeneity (I = 30%, P = .18). Six studies with 3116 patients detected no significant difference in severe renal complication between PST and control groups (RR 1.23, 95%CI 0.84-1.79, P = .28). Postoperative serum creatinine (sCr) at 48 hours was shown to be higher in the PST group (mean difference [MD] 0.03, 95% CI 0.03-0.03; P < .01). The length of hospital stay was decreased slightly by 0.59 day in the PST group (95% CI -0.85 to -0.33; P < .01). Perioperative statin therapy seems to jeopardize short-term renal outcome in patients undergoing cardiac surgery, but the occurrence of severe renal complication was not affected.

Perioperative Statins Do Not Prevent Acute Kidney Injury After Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

To evaluate whether perioperative statins reduce the risk of acute kidney injury (AKI) after cardiac surgery. Systematic review and meta-analysis of randomized trials. Perioperative management in hospitals that perform cardiac surgery. Adult patients undergoing cardiac surgery. PubMed, EMBASE, and the Cochrane Library databases were searched for randomized trials. Random-effects meta-analyses were performed to compare the effects of statins versus placebo/control. Trial sequential analysis was conducted to confirm the results. The primary outcome was incidence of postoperative AKI. Eight trials enrolling 3,204 patients were included. The statin arms and the control arms were comparable in incidence of postoperative AKI (risk ratio [RR] = 1.02, 95% confidence interval [CI] = 0.82-1.28), need for renal replacement therapy (RR = 1.09, 95% CI = 0.45-2.66), mechanical ventilation duration (mean difference [MD] = 24.84 min, 95% CI = -55.53-105.20), intensive care unit length of stay (MD = 0.04 days, 95% CI = -3.13-3.20), hospital length of stay (MD = -0.08 days, 95% CI = -0.31-0.15), and in-hospital mortality (RR = 3.76, 95% CI = 0.93-15.14). Trial sequential analysis confirmed that it is unlikely that perioperative statin therapy could achieve a 20% or more relative risk reduction in AKI incidence. Among patients undergoing cardiac surgery, perioperative statin treatment did not reduce the risk of AKI. Statin therapy should not be initiated to prevent AKI following cardiac surgery.

Are perioperative statins beneficial for cardiac surgery?

The use of perioperative statins has been proposed as a measure to reduce morbidity and mortality in cardiac surgery. However, their clinical role is controversial. Searching in Epistemonikos database, which is maintained by screening multiple databases, we identified 36 systematic reviews comprising 92 primary studies addressing the question of this article, including 22 randomized trials. We extracted data, combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded perioperative statins probably do not decrease mortality in cardiac surgery and it is unclear if they have any benefit because the certainty of the evidence is very low.