Beta-blockers lower mortality after non-cardiac surgery

The use of preoperative beta-blockade to minimise the cardiovascular risks of noncardiac surgery has remained controversial for some time, and recent studies have suggested that preoperative beta-blockade may be now decreasing as a result. The purpose of this study was to determine whether early preoperative exposure to beta-blockers could influence 30-day postoperative outcomes in patients undergoing noncardiac surgery.

This was a retrospective analysis examining 136,745 patients (1:1 matched on propensity scores) who were given beta-blockers on the day of or following major non cardiac surgery. 104 VA hospitals were involved. The main outcome measure was 30-day mortality and cardiac morbidity (cardiac arrest or Q-wave myocardial infarction).

55,138 (40.3%) of patients were exposed to beta-blockers, with those undergoing vascular surgery most likely to receive beta-blockade (66.7% of all patients undergoing vascular surgery). 1.1% of patients died and cardiac morbidity occurred among 0.9% of patients. After the propensity matching, beta-blocker use was associated with lower mortality (relative risk 0.73, P<0.001). When stratified by cumulative numbers of Revised Cardiac Risk Index factors, beta-blocker exposure was associated with significantly lower mortality in patients with 2,3, and 4 risk factors, however this association was limited to patients undergoing nonvascular surgery. A lower rate of cardiac arrest and nonfatal Q-wave infarction was seen in patients given beta-blockers (P<0.001), but this again was limited to non-vascular surgery only.

Conclusions:

Following propensity matching, preoperative beta-blockade was associated with lower rates of 30-day mortality in patients with 2 or more Revised Cardiac Risk Index Factors undergoing non-cardiac, non-vascular surgery.

  • London MJ, Hur K, Schwartz GG et al. Association of Perioperative Beta-Blockade With Mortality and Cardiovascular Morbidity Following Major Noncardiac surgery. JAMA 2013;309:1704-1713.