title: Perioperative beta-blocker withdrawal and mortality in vascular surgical patients.
abstract: OBJECTIVE
  Our purpose was to determine the effect of postoperative beta-blocker withdrawal on mortality and cardiovascular events after vascular surgery.
  
  
  METHODS
  Detailed data were collected on perioperative cardiovascular medication use and discontinuation and cardiovascular risk factors among consecutive major vascular surgical procedures at two university hospitals.
  
  
  RESULTS
  A total of 140 patients received beta-blockers preoperatively. Mortality in the 8 patients who had beta-blockers discontinued postoperatively (50%) was significantly greater than in 132 patients who had beta-blockers continued (1.5%, odds ratio 65.0, P<.001). The effect of beta-blocker discontinuation was unaffected by adjustment by stratification for risk factors (all P< or =.01), for contraindications to restarting beta-blockers (P = .006), and by multivariable analyses adjusting for potential confounders (adjusted odds ratio 17.0, P =.01). beta-Blocker discontinuation also was associated with increased cardiovascular mortality (0% vs 29%, P =.005) and postoperative myocardial infarction (odds ratio 17.7, P =.003).
  
  
  CONCLUSIONS
  Discontinuing beta-blockers immediately after vascular surgery may increase the risk of postoperative cardiovascular morbidity and mortality.
authors.affiliation: Division of General Internal Medicine, Cornell Medical Associates, Weill Medical College of Cornell University, New York, NY, USA. jshammas@med.cornell.edu
authors.forename: J B
authors.initials: JB
authors.lastname: Shammash
authors.forename: J C
authors.initials: JC
authors.lastname: Trost
authors.forename: J M
authors.initials: JM
authors.lastname: Gold
authors.forename: J A
authors.initials: JA
authors.lastname: Berlin
authors.forename: M A
authors.initials: MA
authors.lastname: Golden
authors.forename: S E
authors.initials: SE
authors.lastname: Kimmel
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects*; D000368:Aged; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000401:mortality*; D006801:Humans; D011184:Postoperative Period; D011300:Preoperative Care; D012307:Risk Factors; D013375:Substance Withdrawal Syndrome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
chemical_list: D000319:Adrenergic beta-Antagonists