Benefits Found with Perioperative Beta-Blocker Use Among High-Risk Patients

Internal Medicine World ReportAugust 2005

Benefits Found with Perioperative Beta-Blocker Use Among High-Risk Patients

From the Annual Meeting of the American Public Health Association

SAN FRANCISCO—Increasing perioperative beta-blocker use in routine clinical practice among high-risk patients undergoing noncardiac surgery may improve quality of care and reduce mortality, according to new findings presented at the American Public Health Association annual meeting.

“We found that there was a 40% reduction in hospital mortality among patients receiving perioperative beta blockers compared with nonusers,” said lead investigator Dheeresh Mamidi, MD, of theUniversity of Massachusetts, Amherst.

Other randomized trials have shown that beta blockers administered to selected patients undergoing major noncardiac surgery can reduce their incidence of cardiac complications and mortality; however, little is known about perioperative beta-blocker among high-risk patients undergoing major noncardiac surgeries, Dr Mamidi noted.

This study included 782,969 patients (>18 years of age) who underwent major noncardiac surgery in 2000 or 2001. A Revised Cardiac Risk Index (RCRI) score was computed using International Classification of Diseases, Ninth Revision, Clinical Modification codes for each patient. The researchers assigned 1 point each for high-risk surgery, ischemic heart disease, cerebrovascular disease, chronic renal insufficiency, or diabetes mellitus. Patients with an RCRI score of ³1 and no contraindications were considered ideal candidates for perioperative beta-blocker use.

Rates of in-hospital mortality among patients receiving or not receiving perioperative beta-blocker were compared, assessing beta-blocker use according to individual and hospital characteristics. Of patients undergoing major noncardiac surgery, 44% (343,415) appeared to be ideal candidates. Among those, 21% (70,793) were treated with beta blockers from the first or second day of hospital admission.

Dr Dheeresh said greater use of beta blockers was seen among patients ages ³65 years and for each risk factor. Use of beta blockers varied by hospital size and region. Compared with ideal, untreated candidates, those treated prophyllactically had significantly lower in-hospital mortality across all RCRI strata.

“I strongly recommend that beta blockers be used on the first or second day of admission for all the patients at high risk undergoing noncardiac surgery,” said Dr Dheeresh. Although the study only looked at perioperative beta-blocker 1 to 2 days before surgery, these types of patients may benefit the most if the therapy is begun 7 days before surgery. “Primary care physicians may want to consider ordering beta blockers prophylactically before [patients] are admitted,” he added.

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