All Content

Increased Mortality With Perioperative Beta-Blockade in Low-Risk Patients Undergoing Noncardiac Surgery


Clinical question: Does the use of perioperative beta-blockers affect the outcomes in patients undergoing noncardiac surgery?

Bottom line: Determining the presence or absence of cardiac risk factors is important when deciding whether to use beta-blockers during the perioperative period for patients undergoing noncardiac surgery. This study shows that although perioperative beta-blockade may benefit patients with high cardiac risk, it increases short-term mortality in those with no cardiac risk factors. (LOE = 2b)

Reference: Friedell ML, Van Way CW, Freyberg RW, Almenoff PL. Beta-blockade and operative mortality in noncardiac surgery: harmful or helpful. JAMA Surg. 2015;150(7):658-663.

Study design: Cohort (retrospective)

Funding source: Unknown/not stated

Allocation: Uncertain

Setting: Inpatient (any location) with outpatient follow-up

Synopsis: Using data collected from the Veterans Health Administration, these investigators identified more than 325,000 patients hospitalized for surgery. The use of perioperative beta-blockers in this cohort was determined by using pharmacy data. It was unclear whether the beta-blocker was a new medication or a continuation of a home medication and the study did not measure if the beta-blocker was given preoperatively or postoperatively.

Each patient was assigned a cardiac risk score (1 point each for the presence of renal failure, coronary artery disease, diabetes, and abdominal/thoracic surgery) and grouped into 1 of 3 categories: 0 risk factors, 1 to 2 risk factors, and 3 to 4 risk factors. The results showed that the effect of the beta-blockers on mortality varied according to the presence of cardiac risk factors in patients undergoing noncardiac surgery (n = 314,114). In an adjusted analysis, patients with no cardiac risk factors who received beta-blockers had increased 30-day mortality compared with those who did not receive beta-blockers (odds ratio [OR] 1.19, 95% CI 1.06-1.35).

The opposite was true for patients with 3 to 4 cardiac risk factors: Those who received beta-blockers were less likely to die than those who did not receive them (OR 0.63, 95% CI 0.43-0.93). For patients with 1 to 2 risk factors, there was a nonsignificant reduction in mortality with the use of beta-blockers. For the minority of the cohort who actually underwent cardiac surgery (n = 12,375), there was no significant interaction seen between the number of cardiac risk factors and the use of beta-blockers on mortality. Of note, more than 90% of patients in this study population were men, thus these findings may not be generalizable to women.

Dr. Kulkarni is an assistant professor of hospital medicine at Northwestern University in Chicago.

Next Article:

   Comments ()