Clinical question: In patients undergoing noncardiac surgery, are peri-operative beta blockers beneficial in those at high risk and harmful in those at low risk?
Background: Despite multiple RCTs, the exact utility of peri-operative beta-blockade remains unclear, especially in those patients considered low cardiac risk. While initial research prompted guidelines that encouraged the liberal use of peri-operative beta blockers, more recent studies have drawn attention to their potential adverse effects, prompting further investigation.
Study design: Retrospective, observational, cohort study.
Setting: One hundred nineteen Veterans Administration medical centers.
Synopsis: Through the modeling of data from 326,489 patients who underwent noncardiac surgery between 2008 and 2013, this study assessed the effects of beta blocker usage and cardiac risk factors on 30-day surgical mortality.
Analysis demonstrated a significant difference in the effect of beta blocker use on mortality based on the number of cardiac risk factors. For patients with no cardiac risk factors, those receiving beta blockers were at increased risk of death (odds ratio 1.19, 95% confidence interval 1.06-1.35). Among patients with three to four cardiac risk factors, however, those on beta blockers had a decreased risk of death (odds ratio 0.63, 95% confidence interval 0.43-0.93).
Bottom line: In noncardiac surgery, use of beta blockers may be beneficial for those at high cardiac risk and detrimental to those without cardiac risk factors.
Citation: Friedell ML, Van Way CW 3rd, Freyberg RW, Almenoff PL. Beta-blockade and operative mortality in noncardiac surgery: harmful or helpful? JAMA Surgery. 2015;150(7):658-664. doi:10.1001/jamasurg.2015.86.
