By Sahar Bedrood B.S. and Asher Kimchi M.D.

Springfield, MA - Periopertive treatment with beta-blockers is widely advocated to prevent post-operative cardiovascular complications. Dr. Peter Lindenauer et al from Baystate Medical Center in Springfield, Massachusetts conducted a retrospective cohort study of patients 18 years of age or older who underwent major noncardiac surgery. Patients who were administered beta-blockers were compared to those who were not administered beta-blockers prior to surgery. This study, published in the July 28, 2005 issue of The New England Journal of Medicine, shows that perioperative beta-blocker therapy is associated with a reduced risk of in-hospital death among high-risk, but not low-risk, patients undergoing major noncardiac surgery. Increasing the use of beta-blockers in high-risk patients may enhance patient safety. 

Results of the study indicate that of 782,969 patients, 663,635 (85 percent) had no recorded contraindications to beta-blockers, 122,338 of whom (18 percent) received such treatment during the first two hospital days, including 14 percent of patients with a Revised Cardiac Risk Index (RCRI) score of 0 and 44 percent with a score of 4 or higher. The relationship between perioperative beta-blocker treatment and the risk of death varied directly with cardiac risk; among the 580,665 patients with an RCRI score of 0 or 1, treatment was associated with no benefit and possible harm, whereas among the patients with an RCRI score of 2, 3, or 4 or more, the adjusted odds ratios for death in the hospital were 0.88 (95 percent confidence interval, 0.80 to 0.98), 0.71 (95 percent confidence interval, 0.63 to 0.80), and 0.58 (95 percent confidence interval, 0.50 to 0.67), respectively. 

The study found that perioperative administration of beta-blockers was associated with a reduced risk of death in the hospital among high-risk patients undergoing major noncardiac surgery. While the results of large randomized trials become available, efforts need to be made to increase perioperative use of beta-blockers among high-risk patients.  

Co-authors: Peter K. Lindenauer, M.D., Penelope Pekow, Ph.D., Kaijun Wang, M.S., Dheeresh K. Mamidi, M.B., B.S., M.P.H., Benjamin Gutierrez, Ph.D., and Evan M. Benjamin, M.D.