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Beta-blocker prophylaxis for total knee arthroplasty patients: a case series
Kathryn A Heim1, Mark P Lachiewicz, Elizabeth S Soileau
1Fort Worth Affiliated Hospitals Orthopaedic Residency Program at JPS Health Network, Fort Worth, TX, USA.
Journal of Surgical Orthopaedic Advances
|November 20, 2010
Summary
Perioperative beta-blocker prophylaxis in total knee arthroplasty significantly reduced cardiac complications. This protocol ensured most patients received medication, leading to low in-hospital cardiac events and zero 90-day mortality.
Area of Science:
- Orthopedic Surgery
- Cardiology
- Pharmacology
Background:
- Cardiac complications are a rare but serious risk following total knee arthroplasty (TKA).
- Beta-blocker medication has demonstrated efficacy in reducing cardiac deaths in non-cardiac surgeries.
- Implementing a perioperative beta-blocker protocol in TKA may mitigate cardiac risks.
Purpose of the Study:
- To evaluate the safety and incidence of in-hospital cardiac complications in TKA patients managed under a perioperative beta-blocker prophylaxis protocol.
- To assess the adherence and prescription rates of beta-blocker prophylaxis by orthopedic surgeons within an institutional protocol.
- To compare cardiac outcomes among TKA patients who received beta-blockers versus those who did not.
Main Methods:
- A consecutive cohort of 267 total knee arthroplasty patients was studied.
- Patients were categorized into three groups: pre-existing beta-blocker use, surgeon-prescribed beta-blocker, and no beta-blocker.
- In-hospital cardiac complications and 90-day mortality were the primary endpoints.
Main Results:
- 203 out of 267 patients (76%) received perioperative beta-blocker prophylaxis.
- Beta-blocker medication was prescribed by the orthopedic surgeon in 93 patients (34.8%).
- No 90-day mortality was observed; two nonfatal myocardial infarctions (0.7%) and six other cardiac complications (2.2%) occurred.
Conclusions:
- A perioperative beta-blocker prophylaxis protocol is safe and effective in reducing cardiac complications after total knee arthroplasty.
- The protocol led to high medication uptake, with a significant proportion prescribed by the orthopedic surgeon.
- Low rates of in-hospital cardiac morbidity suggest the benefit of beta-blocker use in this patient population.
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