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Association between Perioperative Beta-blocker Use and Surgical Outcomes
Richman JS, Henderson WG, Itani LM, Vick CC, Hawn MT. Association between Perioperative Beta-blocker Use and Surgical Outcomes. Paper presented at: American College of Surgeons Annual Surgical Forum Session; 2012 Oct 3; Chicago, IL.
Objectives: Studies on the effectiveness of perioperative beta blockers in reducing adverse post-operative cardiac events have produced inconsistent findings. We examined associations between VA Surgical Quality Improvement Program (VASQIP)-assessed outcomes and adherence to the Surgical Care Improvement Program measure of perioperative beta-blocker use by patients prescribed beta-blockers prior to surgery (BB-SCIP).
Method: National VA data including BB-SCIP adherence were matched with VASQIP data for 16,906 non-emergent, non-cardiac surgeries in 2006-2009. Bivariate associations were examined using chi-square tests. To control for confounding, propensity score matched analyses were run on 1,000 bootstrapped samples of the data to estimate odds ratios and confidence intervals. To assess consistency, separate matched analyses were carried out using propensity scores derived from logistic regression and classification trees.
Results: Overall adherence to the BB-SCIP was 91.0%. No bivariate association was evident between BB-SCIP adherence and the composite cardiac outcome of MI or cardiac arrest (OR 1.11, p = 0.73) or 30-day mortality (OR 1.12, p = 0.61). BB-SCIP adherence was associated with increased risk of Stroke (OR 7.32, p = 0.027), Sepsis (OR 1.91, p < 0.01), and Renal Insufficiency (OR 2.34, p = 0.03). Results of both propensity-matched analyses were consistent with these findings.
Conclusions: Adherence to BB-SCIP measure was not associated with a reduction in peri-operative cardiac events or mortality, but was associated with increased complications. These findings suggest that perioperative beta blocker use may lead to increased postoperative morbidity among patients on chronic beta blocker therapy. Further study is warranted on the safety of this measure.