Impact of prophylactic postoperative beta-blockade on post-cardiothoracic surgery length of stay and atrial fibrillation.
BACKGROUND
Previous studies have shown that post-cardiothoracic surgery atrial fibrillation (AF) increases the risk of hospital length of stay (LOS), overall mortality, pulmonary edema, and need for a balloon pump. A meta-analysis of 2 previous trials showed a nonsignificant reduction in LOS with postoperative beta-blockers but only encompassed 1200 patients, with few valve surgery patients, and neither study used a hospital within the US.


OBJECTIVE
To evaluate the impact of postoperative beta-blockers on LOS and AF. Secondary endpoints of overall mortality, pulmonary edema, and need for an intra-aortic balloon pump (IABP) were also evaluated between groups.


METHODS
This was a prospective cohort evaluation of all patients undergoing cardiothoracic surgery at our institution between October 1999 and October 2003. Patients receiving prophylactic postoperative beta-blockers were matched (1:1) with patients not receiving prophylaxis for age >70 years, valvular surgery, history of AF, gender, and use of preoperative digoxin and beta-blockers.


RESULTS
Patients (n = 1660) receiving postoperative beta-blockade had a reduction in LOS (mean +/- SD 10.22 +/- 11.38 vs 12.40 +/- 15.67; p = 0.001) and AF (23.5% vs 28.4%; p = 0.02). Mortality, pulmonary edema, and need for IABP were reduced by >50% (p < 0.001; p = 0.001; p < 0.001, respectively), while myocardial infarction and stroke were not significantly impacted.


CONCLUSIONS
In this observational cohort study, prophylactic postoperative beta-blocker use was associated with shorter hospital LOS by an average of 2.2 days and a 17.3% lower incidence of AF. It may also be associated with reductions in overall mortality, pulmonary edema, and need for an IABP.
Coleman
Craig I
CI
School of Pharmacy, University of Connecticut, Storrs, CT, USA.
Perkerson
Kristen A
KA
Gillespie
Effie L
EL
Kluger
Jeffrey
J
Gallagher
Robert
R
Horowitz
Sheryl
S
White
C Michael
CM
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D001262:Atenolol / Q000008:administration & dosage / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007902:Length of Stay; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000209:etiology / Q000517:prevention & control; D020521:Stroke / Q000209:etiology / Q000517:prevention & control
D000319:Adrenergic beta-Antagonists; D001262:Atenolol; D008790:Metoprolol