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Previous Volume 353:349-361 July 28, 2005 Number 4 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Editorial by Poldermans, D. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Despite limited evidence from randomized trials, perioperative treatment with beta-blockers is now widely advocated. We assessed the use of perioperative beta-blockers and their association with in-hospital mortality in routine clinical practice.

Methods We conducted a retrospective cohort study of patients 18 years of age or older who underwent major noncardiac surgery in 2000 and 2001 at 329 hospitals throughout the United States. We used propensity-score matching to adjust for differences between patients who received perioperative beta-blockers and those who did not receive such therapy and compared in-hospital mortality using multivariable logistic modeling.

Results 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.

Conclusions 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. Patient safety may be enhanced by increasing the use of beta-blockers in high-risk patients.

Source Information

From the Division of Healthcare Quality, Baystate Medical Center, Springfield, Mass. (P.K.L., P.P., E.M.B.); the Department of Medicine, Tufts University School of Medicine, Boston (P.K.L., E.M.B.); the School of Public Health and Health Sciences, University of Massachusetts at Amherst, Amherst (P.P., K.W., D.K.M.); and Premier Healthcare Informatics, Premier Inc., Charlotte, N.C. (B.G.)

Address reprint requests to Dr. Lindenauer at the Division of Healthcare Quality, Baystate Medical Center, 759 Chestnut St. P-5928, Springfield, MA 01199, or at Peter.Lindenauer{at}bhs.org.

Full Text of this Article

Related Letters:

Perioperative Beta-Blocker Therapy and Mortality
Vandenbunder B., Mignon A., Dunn P. F., Landesberg G., Tran H. A., Tran P. H., Lindenauer P. K., Pekow P., Benjamin E. M.
Extract | Full Text | PDF  
N Engl J Med 2005; 353:2513-2515, Dec 8, 2005. Correspondence

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