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Am J Cardiol. 2017 Oct 15;120(8):1293-1297. doi: 10.1016/j.amjcard.2017.07.012. Epub 2017 Jul 24.

Effect of Preoperative Beta-Blocker Use on Outcomes Following Cardiac Surgery.

Author information

1
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: jason.b.oneal@vanderbilt.edu.
2
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
3
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
4
Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
5
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee.

Abstract

Recent studies suggest that the use of preoperative β blockers in cardiac surgery may not provide improved mortality rates and may even contribute to negative clinical outcomes. We therefore assessed the role of β blockers on several outcomes after cardiac surgery (delirium, acute kidney injury [AKI], stroke, atrial fibrillation (AF), mortality, and hospital length of stay) in 4,076 patients who underwent elective coronary artery bypass grafting, coronary artery bypass grafting + valve, or valve cardiac surgery from November 1, 2009, to September 30, 2015, at Vanderbilt Medical Center. Clinical data from 2 prospectively collected datasets at our institution were reviewed: the Cardiac Surgery Perioperative Outcomes Database and the Society of Thoracic Surgeons Database. Preoperative β-blocker use was defined by Society of Thoracic Surgeons guidelines as patients receiving a β blocker within 24 hours preceding surgery. Of the included patients, 2,648 (65.0%) were administered a β blocker within 24 hours before surgery. Adjusting for possible confounders, preoperative β-blocker use was associated with increased odds of AKI stage 2 (odds ratio 1.96, 95% confidence interval 1.19 to 3.24, p <0.01). There was no evidence that β-blocker use had an independent association with postoperative delirium, AKI stages 1 and 3, stroke, AF, mortality, or prolonged length of stay. A secondary propensity score analysis did not show a marginal association between β-blocker use and any outcome. In conclusion, we did not find significant evidence that preoperative β-blocker use was associated with postoperative delirium, AF, AKI, stroke, or mortality.

PMID:
28826895
PMCID:
PMC5675103
DOI:
10.1016/j.amjcard.2017.07.012
[Indexed for MEDLINE]
Free PMC Article

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