title: β-Blockade and Operative Mortality in Noncardiac Surgery: Harmful or Helpful?
abstract: OBJECTIVE
  The use of perioperative pharmacologic β-blockade in patients at low risk of myocardial ischemic events undergoing noncardiac surgery (NCS) is controversial because of the risk of stroke and hypotension. Published studies have not found a consistent benefit in this cohort.
  
  
  OBJECTIVE
  To determine the effect of perioperative β-blockade on patients undergoing NCS, particularly those with no risk factors.
  
  
  METHODS
  This is a retrospective observational analysis of patients undergoing surgery in Veterans Affairs hospitals from October 1, 2008, through September 31, 2013.
  
  
  METHODS
  β-Blocker use was determined if a dose was ordered at any time between 8 hours before surgery and 24 hours postoperatively. Data from the Veterans Affairs electronic database included demographics, diagnosis and procedural codes, medications, perioperative laboratory values, and date of death. A 4-point cardiac risk score was calculated by assigning 1 point each for renal failure, coronary artery disease, diabetes mellitus, and surgery in a major body cavity. Previously validated linear regression models for all hospitalized acute care medical or surgical patients were used to calculate predicted mortality and then to calculate odds ratios (ORs).
  
  
  METHODS
  The end point was 30-day surgical mortality.
  
  
  RESULTS
  There were 326,489 patients in this cohort: 314,114 underwent NCS and 12,375 underwent cardiac surgery. β-Blockade lowered the OR for mortality significantly in patients with 3 to 4 cardiac risk factors undergoing NCS (OR, 0.63; 95% CI, 0.43-0.93). It had no effect on patients with 1 to 2 risk factors. However, β-blockade resulted in a significantly higher chance of death in patients (OR, 1.19; 95% CI, 1.06-1.35) with no risk factors undergoing NCS.
  
  
  CONCLUSIONS
  In this large series, β-blockade appears to be beneficial perioperatively in patients with high cardiac risk undergoing NCS. However, the use of β-blockers in patients with no cardiac risk factors undergoing NCS increased risk of death in this patient cohort.
authors.affiliation: Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Friedell
authors.affiliation: Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Van Way
authors.affiliation: Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio.
authors.forename: Ron W
authors.initials: RW
authors.lastname: Freyberg
authors.affiliation: Veterans Affairs Medical Center-Kansas City, Kansas City, Missouri.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Almenoff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D005500:Follow-Up Studies; D017202:Myocardial Ischemia / Q000401:mortality / Q000517:prevention & control; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000401:mortality; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists