Pleiotropic Effects And Clinical Implications of Statin Therapy Post Cardiac Surgery

Background: Perioperative statin therapy can have pleiotropic effects beyond reducing plasma cholesterol level. Whether perioperative statin therapy can reduce surgical infection after cardiac surgery remains unclear. We aimed to assess whether preoperative statin therapy is associated with a reduced risk of surgical site infections and pneumonia after cardiac surgery.Methods: This retrospective cohort study included 1902 adult patients who had cardiac surgery between February 2015 and April 2019 at a major cardiothoracic centre in Western Australia. The primary outcomes were surgical site infections and pneumonia; secondary outcomes were inotrope requirement, duration of mechanical ventilation, intensive care unit (ICU) and hospital stay, and 30-day mortality. We used propensity-score matching to minimise confounding.Results: Following propensity-score matching (N=1098), patients on preoperative statins (n=551) were associated with a reduced risk of postoperative wound infections (0.7% vs 13.9%, adjusted odds ratio [OR] 0.010, 95% confidence interval [CI] 0.001-0.075, P<0.001) and pneumonia (38.3% vs 52.5%, adjusted OR 0.359, 95% CI 0.278-0.464, P<0.001). The length of ICU (40.7 hrs vs 46.0 hrs, P=0.001) and hospital stay (9 days vs 10 days, P=0.016) were both also significantly shorter among those treated with preoperative statin than those without statin therapy. In the subgroup of patients who underwent non-bypass-grafting surgery, preoperative statin was associated with a reduced risk of 30-day mortality (1.5% vs 5.5%, OR 0.106, 95% CI 0.014-0.812, P=0.028).Conclusions: Use of statin before cardiac surgery was associated with a reduced risk of postoperative surgical site infections and pneumonia.