General thoracic surgery: Lung cancer
Beneficial effects of perioperative statins for major pulmonary resection

https://doi.org/10.1016/j.jtcvs.2014.12.016Get rights and content
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Objectives

Statins improve overall outcomes after noncardiac surgery. The primary aim of the study was to determine whether use of perioperative atorvastatin reduced the rate of postoperative complications in patients undergoing pulmonary resection.

Methods

This was a prospective, randomized, placebo-controlled, double-blind trial of patients undergoing elective pulmonary resection who received atorvastatin (40 mg daily) or placebo beginning 1 week before surgery and continued for 1 week postoperatively. Patient characteristics and postoperative complications were recorded. Plasma inflammatory markers were sampled at baseline, in the post-anesthesia care unit, and on postoperative day 3. Because of difficulty enrolling statin-naive patients, the study was stopped at the interim analysis.

Results

Postoperative complications occurred in 16 of 72 patients (22%) receiving placebo and in 8 of 65 patients (12%) receiving atorvastatin (P = .13). For patients undergoing major anatomic resection, there were 24 complications in 15 of 45 placebo-treated patients and 8 complications in 7 of 43 atorvastatin-treated patients (P = .04). Plasma levels of C-reactive protein, tumor necrosis factor-α, and myeloperoxidase did not differ between the 2 treatment arms during the study.

Conclusions

After a 2-week perioperative course of atorvastatin (40 mg) in statin-naïve patients undergoing major pulmonary resection, we found evidence of a reduction in the number of clinically important cardiovascular and pulmonary complications compared with placebo. These promising results merit evaluation in a larger, perhaps multicenter study.

CTSNet classification

24.2
10.4

Abbreviations and Acronyms

CRP
C-reactive protein
MPO
myeloperoxidase
PCU
post-anesthesia care unit
POAF
postoperative atrial fibrillation
TNFα
tumor necrosis factor alpha

Cited by (0)

W.S. and H.T.T. are partly supported by a National Institutes of Health Core Grant P30 CA008748.

Disclosures: David Amar reports consulting fees from ETView. Bernard Park reports lecture fees from Intuitive Surgical. All other authors have nothing to disclose with regard to commercial support.

ClinicalTrial.gov identifier: #NCT00375518.