Continuing beta blockers after noncardiac surgery improves patient outcome
Research Activities, December 2012, No. 388
Administering beta-blockers before non-cardiac surgery has been shown to reduce cardiac events and mortality in high-risk patients. A new study shows that for patients already taking beta-blockers at home, continuing beta-blocker therapy on the day of and after non-cardiac surgery is associated with fewer cardiac events and deaths. Researchers looked at 8,431 patients who underwent elective colorectal and bariatric surgical procedures at 38 hospitals during a 2-year period. Of these, 23.5 percent were taking beta blockers prior to hospital admission for surgery.
The practice of continuing beta-blocker therapy on the day of surgery increased from 57.2 percent at the start of the study to 71.3 percent at the end of the study period. Postoperative beta-blocker use also rose during this period from 75.9 percent to 93.4 percent. The majority of patients (66 percent) continued to receive beta-blockers perioperatively and postoperatively.
Failing to continue beta-blocker therapy during the perioperative period was associated with a nearly twofold risk of 90-day combined adverse events, including death. In these patients, the risk continued to be elevated 1 year after undergoing surgery. Even in patients who did not receive beta blockers on the day of surgery, but continued them postoperatively, the odds of experiencing a 90-day combined adverse event doubled. These findings provide strong evidence for the continuation of beta blockers in patients undergoing these surgical procedures, note the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS20025).
See "Β-blocker continuation after noncardiac surgery," by Steve Kwon, M.D., M.P.H., Rachel Thompson, M.D., Michael Florence, M.D., and others in the May 2012 Archives of Surgery 147(5), pp. 467-473.