Advertisement

Effect of Preoperative Beta-Blocker Use on Outcomes Following Cardiac Surgery

      Recent studies suggest that the use of preoperative β blockers in cardiac surgery may not provide improved mortality rates and may even contribute to negative clinical outcomes. We therefore assessed the role of β blockers on several outcomes after cardiac surgery (delirium, acute kidney injury [AKI], stroke, atrial fibrillation (AF), mortality, and hospital length of stay) in 4,076 patients who underwent elective coronary artery bypass grafting, coronary artery bypass grafting + valve, or valve cardiac surgery from November 1, 2009, to September 30, 2015, at Vanderbilt Medical Center. Clinical data from 2 prospectively collected datasets at our institution were reviewed: the Cardiac Surgery Perioperative Outcomes Database and the Society of Thoracic Surgeons Database. Preoperative β-blocker use was defined by Society of Thoracic Surgeons guidelines as patients receiving a β blocker within 24 hours preceding surgery. Of the included patients, 2,648 (65.0%) were administered a β blocker within 24 hours before surgery. Adjusting for possible confounders, preoperative β-blocker use was associated with increased odds of AKI stage 2 (odds ratio 1.96, 95% confidence interval 1.19 to 3.24, p <0.01). There was no evidence that β-blocker use had an independent association with postoperative delirium, AKI stages 1 and 3, stroke, AF, mortality, or prolonged length of stay. A secondary propensity score analysis did not show a marginal association between β-blocker use and any outcome. In conclusion, we did not find significant evidence that preoperative β-blocker use was associated with postoperative delirium, AF, AKI, stroke, or mortality.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Toppen W.
        • Sareh S.
        • Satou N.
        • Shemin R.
        • Hunter C.
        • Buch E.
        • Benharash P.
        Do preoperative beta-blockers improve postoperative outcomes in patients undergoing cardiac surgery? Challenging societal guidelines.
        Am Surg. 2014; 80: 1018-1021
        • Brinkman W.
        • Herbert M.A.
        • O'Brien S.
        • Filardo G.
        • Prince S.
        • Dewey T.
        • Magee M.
        • Ryan W.
        • Mack M.
        Preoperative beta-blocker use in coronary artery bypass grafting surgery: national database analysis.
        JAMA Intern Med. 2014; 174: 1320-1327
        • Katznelson R.
        • Djaiani G.
        • Mitsakakis N.
        • Lindsay T.F.
        • Tait G.
        • Friedman Z.
        • Wasowicz M.
        • Beattie W.S.
        Delirium following vascular surgery: increased incidence with preoperative beta-blocker administration.
        Can J Anaesth. 2009; 56: 793-801
        • Keller S.
        • Frishman W.H.
        Neuropsychiatric effects of cardiovascular drug therapy.
        Cardiol Rev. 2003; 11: 73-93
        • Khwaja A.
        KDIGO clinical practice guidelines for acute kidney injury.
        Nephron Clin Pract. 2012; 120: c179-c184
        • Ferguson Jr, T.B.
        • Coombs L.P.
        • Peterson E.D.
        Preoperative beta-blocker use and mortality and morbidity following CABG surgery in North America.
        JAMA. 2002; 287: 2221-2227
        • ten Broecke P.W.
        • De Hert S.G.
        • Mertens E.
        • Adriaensen H.F.
        Effect of preoperative beta-blockade on perioperative mortality in coronary surgery.
        Br J Anaesth. 2003; 90: 27-31
        • Zaugg M.
        • Tagliente T.
        • Lucchinetti E.
        • Jacobs E.
        • Krol M.
        • Bodian C.
        • Reich D.L.
        • Silverstein J.H.
        Beneficial effects from beta-adrenergic blockade in elderly patients undergoing noncardiac surgery.
        Anesthesiology. 1999; 91: 1674-1686
        • Brinkman W.T.
        • Herbert M.A.
        • Prince S.L.
        • Magee M.J.
        • Dewey T.M.
        • Smith R.L.
        • Edgerton J.R.
        • Head S.J.
        • Ryan W.H.
        • Mack M.J.
        Preoperative beta-blocker usage: is it really worthy of being a quality indicator?.
        Ann Thorac Surg. 2011; 92 (discussion 795–786): 788-795
        • Vaishnava P.
        • Eagle K.A.
        Surgery. beta—blockers—still a trusted ally or time for retirement?.
        Nat Rev Cardiol. 2014; 11: 502-503
        • Tse L.
        • Schwarz S.K.
        • Bowering J.B.
        • Moore R.L.
        • Barr A.M.
        Incidence of and risk factors for delirium after cardiac surgery at a quaternary care center: a retrospective cohort study.
        J Cardiothorac Vasc Anesth. 2015; 29: 1472-1479
        • O'Neal J.B.
        • Shaw A.D.
        Predicting, preventing, and identifying delirium after cardiac surgery.
        Perioper Med (Lond). 2016; 5: 7
        • Hollinger A.
        • Siegemund M.
        • Goettel N.
        • Steiner L.A.
        Postoperative delirium in cardiac surgery: an unavoidable menace?.
        J Cardiothorac Vasc Anesth. 2015; 29: 1677-1687
        • Machado M.N.
        • Nakazone M.A.
        • Maia L.N.
        Acute kidney injury based on KDIGO (Kidney Disease Improving Global Outcomes) criteria in patients with elevated baseline serum creatinine undergoing cardiac surgery.
        Rev Bras Cir Cardiovasc. 2014; 29: 299-307
        • Devereaux P.J.
        • Beattie W.S.
        • Choi P.T.
        • Badner N.H.
        • Guyatt G.H.
        • Villar J.C.
        • Cina C.S.
        • Leslie K.
        • Jacka M.J.
        • Montori V.M.
        • Bhandari M.
        • Avezum A.
        • Cavalcanti A.B.
        • Giles J.W.
        • Schricker T.
        • Yang H.
        • Jakobsen C.J.
        • Yusuf S.
        How strong is the evidence for the use of perioperative beta blockers in non-cardiac surgery? Systematic review and meta-analysis of randomised controlled trials.
        BMJ. 2005; 331: 313-321
        • Devereaux P.J.
        • Yang H.
        • Yusuf S.
        • Guyatt G.
        • Leslie K.
        • Villar J.C.
        • Xavier D.
        • Chrolavicius S.
        • Greenspan L.
        • Pogue J.
        • Pais P.
        • Liu L.
        • Xu S.
        • Malaga G.
        • Avezum A.
        • Chan M.
        • Montori V.M.
        • Jacka M.
        • Choi P.
        Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial.
        Lancet. 2008; 371: 1839-1847
        • Bin Abd Razak H.R.
        • Yung W.Y.
        Postoperative delirium in patients undergoing total joint arthroplasty: a systematic review.
        J Arthroplasty. 2015; 30: 1414-1417
        • Ely E.W.
        • Inouye S.K.
        • Bernard G.R.
        • Gordon S.
        • Francis J.
        • May L.
        • Truman B.
        • Speroff T.
        • Gautam S.
        • Margolin R.
        • Hart R.P.
        • Dittus R.
        Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU).
        JAMA. 2001; 286: 2703-2710