Impact of perioperative bleeding on the protective effect of β-blockers during infrarenal aortic reconstruction.
BACKGROUND
The use of β-blockers during the perioperative period remains controversial. Although some studies have demonstrated their protective effects regarding postoperative cardiac complications, others have demonstrated increased mortality when β-blockers were introduced before surgery.


METHODS
In this observational study involving 1,801 patients undergoing aortic reconstruction, we prospectively assessed β-blocker therapy compared with no β-blocker therapy, with regard to cardiac and noncardiac postoperative outcomes using a propensity score approach. The impact of β-blockers was analyzed according to the intraoperative bleeding estimated by transfusion requirements.


RESULTS
In-hospital mortality was 2.5% (n=45), β-blocker use was associated with a reduced frequency of postoperative myocardial infarction (OR=0.46, 95% CI [0.26; 0.80]) and myocardial necrosis (OR=0.62, 95% CI [0.43; 0.88]) in all patients, but also with an increased frequency of multiple organ dysfunction syndromes (OR=2.78, 95% CI [1.71; 4.61]). In patients with severe bleeding (n=163; 9.1%), the frequency of in-hospital death (OR=6.65, 95% CI [1.09; 129]) and/or multiple organ dysfunction syndromes (OR=4.18, 95% CI [1.81; 10.38]) were markedly increased. Furthermore, no more than 28% of the patients who died presented with postoperative myocardial infarction, whereas 69% of the patient with a postoperative myocardial infarction also presented an excessive bleeding.


CONCLUSIONS
Perioperative β-blocker therapy was associated with an overall reduction in postoperative cardiac events. In the vast majority of patients with low perioperative bleeding, the global effect of β-blockers was protective; in contrast, patients given β-blockers who experienced severe bleeding had higher mortality and an increased frequency of multiorgan dysfunction syndrome.
University Pierre et Marie Curie-Paris 6, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. yannick.le-manach@psl.aphp.fr
Yannick
Y
Le Manach
Gary S
GS
Collins
Cristina
C
Ibanez
Jean Pierre
JP
Goarin
Pierre
P
Coriat
Julien
J
Gaudric
Bruno
B
Riou
Paul
P
Landais
D058186:Acute Kidney Injury / Q000401:mortality / Q000517:prevention & control*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D001012:Aorta, Abdominal / Q000473:pathology / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000401:mortality / Q000517:prevention & control*; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D019990:Perioperative Care / Q000379:methods* / Q000401:mortality; D011446:Prospective Studies; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists