title: Preoperative beta-blocker use should not be a quality metric for coronary artery bypass grafting.
abstract: BACKGROUND
  Preoperative beta-blockade for coronary artery bypass grafting (CABG) has become an accepted hospital quality metric. However, single-institution reports regarding the benefits of beta-blocker (ß-blocker) use are conflicting. The purpose of this study was to evaluate the associations between preoperative beta-blocker use and outcomes within a large, regional cohort.
  
  
  METHODS
  Patient records from a statewide, multi-institutional Society of Thoracic Surgeons (STS) certified database for isolated CABG operations (2001 to 2011) were extracted and stratified by preoperative ß-blocker use. The influence of preoperative ß-blockers on risk-adjusted outcomes was assessed by hierarchical regression modeling with adjustment for preoperative risk using calculated STS predictive risk indices.
  
  
  RESULTS
  A total of 43,747 (age, 63 years; ß-blocker 80% versus non ß-blocker 20%) patients were included. Median STS predicted risk of mortality scores for ß-blocker patients were incrementally lower (1.2% vs 1.4%, p < 0.001). Non ß-blocker patients more frequently developed pneumonia (3.5% vs 2.8%, p = 0.001), while ß-blocker patients surprisingly had greater intraoperative blood usage (16% vs 11%, p < 0.001). There was no difference in unadjusted mortality (ß-blocker: 1.9% vs non ß-blocker: 2.2%, p = 0.15). After risk adjustment, preoperative ß-blocker use was not associated with mortality (p = 0.63), morbidity, length of stay (p = 0.79), or hospital readmission (p = 0.97).
  
  
  CONCLUSIONS
  Preoperative ß-blocker use is not associated with risk-adjusted mortality, several measures of morbidity, or hospital resource utilization after CABG operations. Thus, these data suggest that the routine use of preoperative ß-blockers for CABG operations should not be used as a measure of surgical quality.
authors: University of Virginia, Charlottesville, Virginia.
authors: Damien J
authors: DJ
authors: LaPar
authors: Ivan K
authors: IK
authors: Crosby
authors: Irving L
authors: IL
authors: Kron
authors: John A
authors: JA
authors: Kern
authors: Edwin
authors: E
authors: Fonner
authors: Jeffrey B
authors: JB
authors: Rich
authors: Alan M
authors: AM
authors: Speir
authors: Gorav
authors: G
authors: Ailawadi
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D001026:Coronary Artery Bypass / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D019984:Quality Indicators, Health Care
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: 23