title: Preoperative β-blocker use in coronary artery bypass grafting surgery: national database analysis.
abstract: OBJECTIVE
  Use of preoperative β-blockers has been associated with a reduction in perioperative mortality for patients undergoing coronary artery bypass grafting (CABG) surgery in observational research studies, which led to the adoption of preoperative β-blocker therapy as a national quality standard.
  
  
  OBJECTIVE
  To determine whether preoperative β-blocker use within 24 hours of CABG surgery is associated with reduced perioperative mortality in a contemporary sample of patients.
  
  
  METHODS
  Retrospective analysis of the Society of Thoracic Surgeons National Adult Cardiac database for 1107 hospitals performing cardiac surgery in the United States from January 1, 2008, through December 31, 2012. Participants included 506,110 patients 18 years and older undergoing nonemergent CABG surgery who had not experienced a myocardial infarction in the prior 21 days or any other high-risk presenting symptom. We used logistic regression and propensity matching with a greedy 5-to-1 digit-matching algorithm to examine the association between β-blocker use and the main outcomes of interest.
  
  
  METHODS
  Preoperative β-blocker use.
  
  
  METHODS
  Incidence of perioperative mortality, permanent stroke, prolonged ventilation, any reoperation, renal failure, deep sternal wound infection, and atrial fibrillation.
  
  
  RESULTS
  Among the 506,110 patients undergoing CABG surgery who met the inclusion criteria, 86.24% received preoperative β-blockers within 24 hours of surgery. In propensity-matched analyses that included 138,542 patients, we found no significant difference between patients who did and did not receive preoperative β-blockers in rates of operative mortality (1.12% vs 1.17%; odds ratio [OR], 0.96 [95% CI, 0.87-1.06]; P = .38), permanent stroke (0.97% vs 0.98%; OR, 0.99 [95% CI, 0.89-1.10]; P = .81), prolonged ventilation (7.01% vs 6.86%; OR, 1.02 [95% CI, 0.98-1.07]; P = .26), any reoperation (3.60% vs 3.69%; OR, 0.97 [95% CI, 0.92-1.03]; P = .35), renal failure (2.33% vs 2.24%; OR, 1.04 [95% CI, 0.97-1.11]; P = .30), and deep sternal wound infection (0.29% vs 0.34%; OR, 0.86 [95% CI, 0.71-1.04]; P = .12). However, patients who received preoperative β-blockers within 24 hours of surgery had higher rates of new-onset atrial fibrillation when compared with patients who did not (21.50% vs 20.10%; OR, 1.09 [95% CI, 1.06-1.12]; P < .001). Results of logistic regression analyses were broadly consistent.
  
  
  CONCLUSIONS
  Preoperative β-blocker use among patients undergoing nonemergent CABG surgery who have not had a recent myocardial infarction was not associated with improved perioperative outcomes.
authors.affiliation: Cardiopulmonary Research Science and Technology Institute, Dallas, Texas.
authors.forename: William
authors.initials: W
authors.lastname: Brinkman
authors.affiliation: Department of Clinical Research, Medical City Dallas Hospital, Dallas, Texas.
authors.forename: Morley A
authors.initials: MA
authors.lastname: Herbert
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Sean
authors.initials: S
authors.lastname: O'Brien
authors.affiliation: Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Filardo
authors.affiliation: Cardiopulmonary Research Science and Technology Institute, Dallas, Texas.
authors.forename: Syma
authors.initials: S
authors.lastname: Prince
authors.affiliation: Cardiopulmonary Research Science and Technology Institute, Dallas, Texas2Department of Clinical Research, Medical City Dallas Hospital, Dallas, Texas.
authors.forename: Todd
authors.initials: T
authors.lastname: Dewey
authors.affiliation: Cardiopulmonary Research Science and Technology Institute, Dallas, Texas2Department of Clinical Research, Medical City Dallas Hospital, Dallas, Texas.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Magee
authors.affiliation: Cardiopulmonary Research Science and Technology Institute, Dallas, Texas.
authors.forename: William
authors.initials: W
authors.lastname: Ryan
authors.affiliation: Cardiopulmonary Research Science and Technology Institute, Dallas, Texas.
authors.forename: Michael
authors.initials: M
authors.lastname: Mack
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology*; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology*; D011300:Preoperative Care / Q000379:methods*; D057216:Propensity Score; D065840:Protective Factors; D051437:Renal Insufficiency / Q000453:epidemiology*; D012086:Reoperation / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology*; D013530:Surgical Wound Infection / Q000453:epidemiology; D014481:United States
chemical_list: D000319:Adrenergic beta-Antagonists