title: Beta-blocker prophylaxis for total knee arthroplasty patients: a case series.
abstract: Cardiac complications are an infrequent yet undesirable cause of morbidity and mortality following total knee arthroplasty. Perioperative prophylaxis with beta-blocker medication has been shown to reduce in-hospital cardiac deaths in noncardiac surgical patients. This study evaluated the safety and in-hospital cardiac complications of a consecutive cohort of 267 total knee arthroplasties in patients who followed a perioperative beta-blocker prophylaxis institutional protocol. The patients were categorized into three groups: A, already on a beta-blocker; B, beta-blocker prescribed by orthopaedic surgeon; and C, not given the medication. The 90-day mortality and in-hospital cardiac complications were evaluated. Of the patients who had 267 procedures, 203 (76%) received beta-blocker prophylaxis perioperatively: 110 (41.2%) were already on the medication preoperatively, 93 (34.8%) were prescribed the medication by the surgeon, and 64 (24%) did not receive this medication. There were no deaths within the first 90 days. There were two nonfatal myocardial infarctions (0.7%) and six other cardiac complications (2.2%). With a beta-blocker prophylaxis protocol implemented by one surgeon, 76% of total knee arthroplasty patients were given the medication and it was prescribed in 34.8% by the orthopaedic surgeon. In-hospital cardiac complications were low.
authors.affiliation: Fort Worth Affiliated Hospitals Orthopaedic Residency Program at JPS Health Network, Fort Worth, TX, USA.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Heim
authors.forename: Mark P
authors.initials: MP
authors.lastname: Lachiewicz
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Soileau
authors.forename: Paul F
authors.initials: PF
authors.lastname: Lachiewicz
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control*; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D012086:Reoperation
chemical_list: D000319:Adrenergic beta-Antagonists