July 27, 2005
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
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.