DOI: 10.1097/01.SA.0000365055.82734.91
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Issn Print: 0039-6206
Publication Date: 2010/02/01
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Excerpt
Rita Katznelson,* Goerge N. Djaiani,* Michael R. Borger,† Zeev Friedman,‡ Susan E. Abbey,§ Ludwik Fedorko,* Jacek Karski,* Nicholas Mitsakakis,* Jo Carroll,* and W. Scott Beattie*
(Anesthesiology, 110:67-73, 2009)
*Department of Anesthesiology and Pain Management, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada; †Department of Cardiac Surgery, Herzzentrum Leipzig, Leipzig, Germany; ‡Department of Anesthesia and Pain Management, Mount Sinai Hospital; and §Department of Psychiatry, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Delirium is an acute deterioration of brain function characterized by fluctuating consciousness and an inability to maintain attention. Statin drugs have been shown to lessen morbidity and mortality after major surgical procedures. An association was sought between preoperative administration of statins and postoperative delirium in a large, prospective cohort of patients undergoing cardiac surgery with cardiopulmonary bypass. After institutional review board approval, data were prospectively collected on consecutive patients undergoing cardiac surgery with cardiopulmonary bypass from April 2005 to June 2006 in an academic hospital. All patients were screened for delirium during their hospitalization using the Confusion Assessment Method in the intensive care unit. Multivariate logistic regression analysis was used to identify independent perioperative predictors of delirium after cardiac surgery. Statins were tested for a potential protective effect. One hundred twenty-two (11.5%) of the 1059 patients analyzed had delirium at any time during their cardiac intensive care unit stay. Statins had a protective effect in reducing the odds of delirium by 46%. Independent predictors of postoperative delirium included older age, preoperative depression, preoperative renal dysfunction, complex cardiac surgery, perioperative intraaortic balloon pump support, and massive blood transfusion. The model was reliable (Hosmer-Lemeshow test) and discriminative (area under the receiver operating characteristic curve). Preoperative administration of statins is associated with a lower risk of postoperative delirium after cardiac surgery with cardiopulmonary bypass.
