Effects of statins on postoperative sepsis, systemic inflammatory response syndrome and mortality after colorectal surgery

Introduction

Colorectal surgery carries significant risks of postoperative morbidity and mortality. One of the major hazards is an increased risk of sepsis; an important component of which is systemic inflammatory response syndrome (SIRS). Several recent studies suggest that the noncholesterol-related, pleiotropic effects of statins may limit the development of sepsis and associated inflammation. This study investigates the impact of prior statin therapy on the incidence and outcome of postoperative sepsis and SIRS in colorectal surgery patients.

Methods

A retrospective cohort analysis of 577 patients who underwent curative surgery for colorectal cancer was conducted to evaluate postoperative morbidity and mortality (within 30 days of surgery). The primary endpoints were: 30-day in-hospital mortality, admission to intensive care (ICU), and a positive diagnosis of SIRS or sepsis.

Results

Prior to admission, 21.7% of patients were taking either simvastatin, atorvastatin, fluvastatin, pravastatin or rosuvastatin. Patients on statins were significantly older than those not on statins (statin - 74.7 years (SD = 6.5) vs. nonstatin - 69.2 years (SD = 13.4), P = 0.022), more likely to have pre-existing co-morbidities and in receipt of antidiabetic agents and other cardiovascular drugs. Table 1 shows there was no difference in mortality rate between the two groups. Furthermore, the incidence of nosocomial infection and sepsis did not differ between the statin and nonstatin groups. Despite being more likely to be admitted to the ICU, the statin group was significantly less likely to develop either SIRS (in or out of the ICU) or postoperative wound infection or be admitted to the ICU for infective/inflammatory sequelae.

Table 1 Outcomes for statin and nonstatin patients following colorectal surgery

Conclusion

Statin patients were older than nonstatin patients, and had a greater burden of co-morbidities, yet the mortality rate did not differ between the two groups. The possibility that prior use of statins may influence inflammatory or infective events associated with this surgical procedure is supported by the significantly lower incidence of wound infection, SIRS and sepsis in statin-treated patients, illustrating the potential for statins to confer protection against these insults in the most critically ill patients.