Perioperative Statin Therapy and Renal Outcomes After Major Vascular Surgery: A Propensity-Based Analysis

Kor, Daryl J.; Brown, Michael J.; Iscimen, Remzi; Brown, Daniel R.; Whalen, Francis X.; Roy, Tuhin K.; Keegan, Mark T.

doi:10.1053/j.jvca.2007.12.019

« Previous Next »Journal of Cardiothoracic and Vascular Anesthesia
Volume 22, Issue 2 , Pages 210-216, April 2008

Perioperative Statin Therapy and Renal Outcomes After Major Vascular Surgery: A Propensity-Based Analysis

Daryl J. Kor, MD
- Department of Anesthesiology, Division of Critical Care, Mayo Clinic College of Medicine, Rochester, MN
- Address reprint requests to Daryl J. Kor, MD, Department of Anesthesiology, Division of Critical Care, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905.
Michael J. Brown, MD
- Department of Anesthesiology, Division of Critical Care, Mayo Clinic College of Medicine, Rochester, MN
Remzi Iscimen, MD
- Department of Anesthesiology, Division of Critical Care, Mayo Clinic College of Medicine, Rochester, MN
- Department of Anesthesiology and Reanimation, Uludag University School of Medicine, Bursa, Turkey.
Daniel R. Brown, MD, PhD
- Department of Anesthesiology, Division of Critical Care, Mayo Clinic College of Medicine, Rochester, MN
Francis X. Whalen, MD
- Department of Anesthesiology, Division of Critical Care, Mayo Clinic College of Medicine, Rochester, MN
Tuhin K. Roy, MD, PhD
- Department of Anesthesiology, Division of Critical Care, Mayo Clinic College of Medicine, Rochester, MN
Mark T. Keegan, MD
- Department of Anesthesiology, Division of Critical Care, Mayo Clinic College of Medicine, Rochester, MN

Objective: To evaluate how the presence and timing of statin therapy affect perioperative renal outcomes after major vascular surgery.

Design: Retrospective cohort study.

Setting: Surgical intensive care unit at a single academic medical center.

Participants: Patients undergoing major vascular surgery between July 2004 and October 2005.

Measurements and Main Results: The presence and timing of perioperative statin administration and the propensity for receiving such therapy were noted. Renal outcomes, lengths of stay, and mortality were reviewed. One hundred fifty-one procedures were performed. Eighty-nine patients (59%) received statin therapy. There was no evidence for renal protection with perioperative statin therapy (Δ creatinine 0.2 mg/dL v 0.2 mg/dL, p = 0.41; acute renal injury/acute renal failure 8% v 6%, p = 1.00; renal replacement therapy 3% v 3%, p = 1.00; all statin v no statin, respectively). With the possible exception of early reinstitution of statin therapy in chronic statin users, subgroup analyses failed to confirm an association between statin timing and prevention of postoperative renal dysfunction.

Conclusions: In the present investigation, neither the presence nor timing of perioperative statin therapy was associated with improved renal outcomes in patients undergoing a range of major vascular procedures. A possible exception is early postoperative reinitiation of statin therapy in chronic statin users. The discrepant results of available literature preclude a definitive statement on the use of statin therapy as a means of preventing postoperative renal dysfunction. An adequately powered prospective trial is needed before advocating the routine use of statin therapy for perioperative renal protection.

Key Words: perioperative care, statins, renal failure, renal replacement therapy, vascular surgery