Mohamed R, McAlister FA, Pretorius V, Kapoor AS, Majumdar SR, Ross DB, and Norris CM for the APPROACH Investigators. Preoperative statin use and infection after cardiac surgery: a cohort study. Clin Infect Dis. 2009 Apr 1;48(7):e66-72.

Background: It has been suggested that the routine use of statins preoperatively would reduce the risk of postoperative infection. We conducted this study to explore whether preoperative statin use was associated with infection after cardiac surgery (recipients of which have a higher-than-average risk of postoperative infection).

Methods: We performed secondary analysis of data collected in a prospective cohort study of adults who underwent nontransplant cardiac surgery in a university hospital during the period January 1999 through December 2005. Outcomes were ascertained in a blinded and independent fashion.

Results: Of the 7733 patients, 2657 (34%) were taking statins preoperatively; the proportion increased from 16% during 1999–2000 to 53% during 2003–2005 (P<.001, by test for trend). There was no association between preoperative statin use and postoperative infection: 214 statin users (8.1%) versus 425 statin nonusers (8.4%) developed an infection within 30 days after surgery. Factors associated with increased risk of infection after cardiac surgery included diabetes mellitus, heart failure, chronic obstructive pulmonary disease, increasing age, elevated baseline creatinine level, and longer duration of cardiopulmonary bypass but not statin use (adjusted odds ratio, 1.08; 95% confidence interval, 0.89–1.31).

Conclusions: Preoperative statin use was not associated with a reduction in the rate of postoperative infection among patients who underwent cardiac surgery. This lack of apparent benefit for high-risk patients argues against the routine use of statins as a preoperative strategy for lower-risk patients and supports calls for randomized trials to define whether preoperative statin use influences postoperative rates of infection.

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