title: β-blocker continuation after noncardiac surgery: a report from the surgical care and outcomes assessment program.
abstract: BACKGROUND
  Despite limited evidence of effect, β-blocker continuation has become a national quality improvement metric.
  
  
  OBJECTIVE
  To determine the effect of β-blocker continuation on outcomes in patients undergoing elective noncardiac surgery.
  
  
  METHODS
  The Surgical Care and Outcomes Assessment Program is a Washington quality improvement benchmarking initiative based on clinical data from more than 55 hospitals. Linking Surgical Care and Outcomes Assessment Program data to Washington's hospital admission and vital status registries, we studied patients undergoing elective colorectal and bariatric surgical procedures at 38 hospitals between January 1, 2008, and December 31, 2009.
  
  
  METHODS
  Mortality, cardiac events, and the combined adverse event of cardiac events and/or mortality.
  
  
  RESULTS
  Of 8431 patients, 23.5% were taking β-blockers prior to surgery (mean [SD] age, 61.9 [13.7] years; 63.0% were women). Treatment with β-blockers was continued on the day of surgery and during the postoperative period in 66.0% of patients. Continuation of β-blockers both on the day of surgery and postoperatively improved from 57.2% in the first quarter of 2008 to 71.3% in the fourth quarter of 2009 (P value <.001). After adjusting for risk characteristics, failure to continue β-blocker treatment was associated with a nearly 2-fold risk of 90-day combined adverse event (odds ratio, 1.97; 95% CI, 1.19-3.26). The odds were even greater among patients with higher cardiac risk (odds ratio, 5.91; 95% CI, 1.40- 25.00). The odds of combined adverse events continued to be elevated 1 year postoperatively (odds ratio, 1.66; 95% CI, 1.08-2.55).
  
  
  CONCLUSIONS
  β-Blocker continuation on the day of and after surgery was associated with fewer cardiac events and lower 90-day mortality. A focus on β-blocker continuation is a worthwhile quality improvement target and should improve patient outcomes.
authors.affiliation: Department of Surgery and Surgical Outcomes Research Center, University of Washington, Seattle, WA 98195-6410, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Kwon
authors.forename: Rachel
authors.initials: R
authors.lastname: Thompson
authors.forename: Michael
authors.initials: M
authors.lastname: Florence
authors.forename: Ronald
authors.initials: R
authors.lastname: Maier
authors.forename: Lisa
authors.initials: L
authors.lastname: McIntyre
authors.forename: Terry
authors.initials: T
authors.lastname: Rogers
authors.forename: Ellen
authors.initials: E
authors.lastname: Farrohki
authors.forename: Mark
authors.initials: M
authors.lastname: Whiteford
authors.forename: David R
authors.initials: DR
authors.lastname: Flum
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D050110:Bariatric Surgery / Q000009:adverse effects*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D011300:Preoperative Care; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists