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Vascular Disorders
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my personal edition > vascular disorders > news
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DGDispatch
Perioperative Pattern of Use of Beta Blockers Affects Mortality: Presented at ASA
By Lexa W. Lee
NEW ORLEANS -- October 21, 2009 -- Perioperative beta blockade is associated with a reduction in 30-day and 1-year mortality when administered according to the perioperative cardiac risk reduction protocol (PCRRT); withdrawal of beta blockers perioperatively increases mortality, according to a study presented here at the 2009 Annual Meeting of the American Society of Anesthesologists (ASA).
Perioperative beta blockade has been a standard of care after perioperative atenolol was shown to reduce 2-year mortality. The current study explores the relationship between pattern of use of perioperative beta blockade and perioperative mortality since introduction of PCRRT, said Arthur Wallace, MD, University of California, San Francisco, San Francisco, California, on October 19.
Epidemiologic data from 38,779 operations performed at the San Francisco VA Medical Center were analysed. Most surgeries were on men (36,830), and their average age was 63.4. Surgeries in women were less common (1,949), whose average age was 56.8.
A total of 24,739 inpatient procedures and 14,040 outpatient procedures were reviewed. Inpatients had a higher risk than outpatients (1-year mortality 11% vs 4% for men and 6% vs 1% for women).
In all, 20,303 patients were on a perioperative beta blocker and 18,476 were not. Those taking a beta blocker were older (mean age 66.0 vs 59.8 years, P > .0001); had significantly (P < .0001) more coexisting disease, including a higher incidence of vascular disease (odds ratio [OR] = 2.8), coronary artery disease (OR = 5.5), prior myocardial infarction (OR = 9.3), diabetes (OR = 2.4), hypertension (OR = 2.4), smoking (OR = 1.2), and hyperlipidaemia (OR 2.2); and were aged >65 years (OR = 1.4).
Patients on beta blockers had higher 30-day (OR = 2.0) and 1 year (OR = 1.4) mortalities. Metoprolol was the most common inpatient drug (75%), and atenolol was the most common outpatient drug (54%).
The patients were divided into 4 groups according to their usage pattern of perioperative beta blockers: none, no perioperative beta blockers (48%); addition, no beta blockers before surgery but at least 1 dose after surgery (15%); withdrawal, beta blockers before but not after surgery (5%); and continuous, beta blockers before surgery and at least 1 dose after surgery (33%). Also, 25% of all vascular and 14% of all patients with coronary artery disease and 30% of patients with >=2 risk factors did not receive a beta blocker.
Logistic regression, survival, and propensity analyses were used. Compared with the none group, addition of beta blockers was significantly associated with a reduction in 30-day (P = .0055) and 1-year mortality (P = .0001), continuous use of beta blockers was associated with a reduction in 30-day (P = .037) and 1-year (P = .05) mortality, and withdrawal of beta blockers was associated with an increase in 30-day (P < .0001) and 1-year (P < .0001) mortality.
The presence of coronary artery disease (30-day, P < .0001; 1-year, P < .0084) and peripheral vascular disease (30-day, P < .0001; 1-year, P < .0001) increased the risk of postoperative mortality.
[Presentation title: The Effects of Perioperative Beta Blockers on Mortality. Abstract A705]
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