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Association between Preoperative Statin Therapy and Postoperative Infectious Complications in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis

Published online by Cambridge University Press:  02 January 2015

Imad M. Tleyjeh ,
Faisal A. Alasmari ,
Aref A. Bin Abdulhak ,
Muhammad Riaz ,
Musa A. Garbati ,
Patricia J. Erwin ,
Tarek Kashour ,
Mouaz H. Al-Mallah  and
Larry M. Baddour
Imad M. Tleyjeh*
Affiliation:
Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia Research and Scientific Publication Center, King Fahad Medical City, Riyadh, Saudi Arabia Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota Division of Epidemiology, Mayo Clinic, Rochester, Minnesota
Faisal A. Alasmari
Affiliation:
Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
Aref A. Bin Abdulhak
Affiliation:
Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
Muhammad Riaz
Affiliation:
Research and Scientific Publication Center, King Fahad Medical City, Riyadh, Saudi Arabia
Musa A. Garbati
Affiliation:
Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
Patricia J. Erwin
Affiliation:
Mayo Medical Library, Mayo Clinic, Rochester, Minnesota
Tarek Kashour
Affiliation:
Cardiac Center, King Fahad Medical City, Riyadh, Saudi Arabia
Mouaz H. Al-Mallah
Affiliation:
King Fahad National Guard Hospital, Riyadh, Saudi Arabia; andWayne State University, Detroit, Michigan
Larry M. Baddour
Affiliation:
Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
*
Research and Scientific Publication Center, King Fahd Medical City, Aldabab Street, Riyadh 11525, PO Box 59046, Riyadh, Saudi Arabia (itleyjeh@kfmc.med.satleyjeh.imad@mayo.edu)
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Abstract

Infectious complications of cardiac surgery are often severe and life threatening. Statins having both immunomodulatory and anti-inflammatory effects were intuitively thought to influence the development of postsurgical infections. We sought to systematically examine whether any association exists between statin use and risk of infectious complications in patients undergoing cardiac surgery. We searched Ovid MEDLINE, Ovid EMBASE, Thomson Scientific Web of Science, and Elsevier Scopus from inception through February 2011 for comparative studies examining the association between statin use and risk of postoperative infections in patients undergoing cardiac surgery. We contacted a study's author for missing information. We conducted a random-effects meta-analysis of individual studies' odds ratios (adjusted for potential confounders). We identified 6 cohort studies for inclusion, 3 of which were conducted in Canada and 3 of which were conducted in the United States. Four were single-center studies, and 2 were population based. Exposure ascertainment was based on a review of admission medication list or prescription databases. Infectious outcomes were heterogeneous and included surgical site infections within 30 days, serious infections (sepsis), or any other postoperative infection. Statin use in the preoperative period was associated with a trend toward reduction in the incidence of postoperative infections in patients who underwent cardiac surgery (odds ratio, 0.81 [95% confidence interval, 0.64–1.01]; P = .06; I2 = 75%). Heterogeneity was explained by country effect. Studies performed in Canada showed weaker associations than studies performed in the United States. This difference could not be attributed to study quality alone. We did not find good evidence to support an association between statin use and postoperative infectious complications. However, the trend toward statistical significance for this association indicates that further investigation is warranted.

Type
Review Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 11 , November 2012 , pp. 1143 - 1151
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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