title: Perioperative beta-blocker therapy and mortality after major noncardiac surgery.
abstract: BACKGROUND
  Despite limited evidence from randomized trials, perioperative treatment with beta-blockers is now widely advocated. We assessed the use of perioperative beta-blockers and their association with in-hospital mortality in routine clinical practice.
  
  
  METHODS
  We conducted a retrospective cohort study of patients 18 years of age or older who underwent major noncardiac surgery in 2000 and 2001 at 329 hospitals throughout the United States. We used propensity-score matching to adjust for differences between patients who received perioperative beta-blockers and those who did not receive such therapy and compared in-hospital mortality using multivariable logistic modeling.
  
  
  RESULTS
  Of 782,969 patients, 663,635 (85 percent) had no recorded contraindications to beta-blockers, 122,338 of whom (18 percent) received such treatment during the first two hospital days, including 14 percent of patients with a Revised Cardiac Risk Index (RCRI) score of 0 and 44 percent with a score of 4 or higher. The relationship between perioperative beta-blocker treatment and the risk of death varied directly with cardiac risk; among the 580,665 patients with an RCRI score of 0 or 1, treatment was associated with no benefit and possible harm, whereas among the patients with an RCRI score of 2, 3, or 4 or more, the adjusted odds ratios for death in the hospital were 0.88 (95 percent confidence interval, 0.80 to 0.98), 0.71 (95 percent confidence interval, 0.63 to 0.80), and 0.58 (95 percent confidence interval, 0.50 to 0.67), respectively.
  
  
  CONCLUSIONS
  Perioperative beta-blocker therapy is associated with a reduced risk of in-hospital death among high-risk, but not low-risk, patients undergoing major noncardiac surgery. Patient safety may be enhanced by increasing the use of beta-blockers in high-risk patients.
authors.affiliation: Division of Healthcare Quality, Baystate Medical Center, Springfield, Mass 01199, USA. Peter.Lindenauer@bhs.org
authors.forename: Peter K
authors.initials: PK
authors.lastname: Lindenauer
authors.forename: Penelope
authors.initials: P
authors.lastname: Pekow
authors.forename: Kaijun
authors.initials: K
authors.lastname: Wang
authors.forename: Dheeresh K
authors.initials: DK
authors.lastname: Mamidi
authors.forename: Benjamin
authors.initials: B
authors.lastname: Gutierrez
authors.forename: Evan M
authors.initials: EM
authors.lastname: Benjamin
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control*; D019990:Perioperative Care; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D012189:Retrospective Studies; D012306:Risk; D013514:Surgical Procedures, Operative
chemical_list: D000319:Adrenergic beta-Antagonists