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Preoperative beta-blocker use should not be a quality metric for coronary artery bypass grafting

Damien J LaPar1, Ivan K Crosby, Irving L Kron

  • 1University of Virginia, Charlottesville, Virginia.

The Annals of Thoracic Surgery
|August 24, 2013
PubMed

Insights

Preoperative beta-blocker use before coronary artery bypass grafting (CABG) shows no association with patient mortality or morbidity. These findings suggest that routine beta-blocker use should not be a surgical quality metric for CABG.

Area of Science:

  • Cardiovascular Surgery
  • Anesthesiology
  • Quality Improvement in Healthcare

Background:

  • Preoperative beta-blocker (ß-blocker) administration is a recognized hospital quality metric for coronary artery bypass grafting (CABG).
  • Existing single-institution reports on the benefits of ß-blocker use yield conflicting results.
  • This study aimed to investigate the association between preoperative ß-blocker use and patient outcomes in a large, regional cohort.

Purpose of the Study:

  • To evaluate the association between preoperative beta-blocker use and clinical outcomes in patients undergoing isolated coronary artery bypass grafting (CABG).
  • To assess the impact of preoperative beta-blocker administration on risk-adjusted mortality, morbidity, and hospital resource utilization.

Main Methods:

  • Utilized data from a statewide, multi-institutional Society of Thoracic Surgeons (STS) database for isolated CABG operations between 2001 and 2011.
  • Stratified patients based on preoperative beta-blocker (ß-blocker) use.
  • Employed hierarchical regression modeling to assess the influence of preoperative ß-blockers on risk-adjusted outcomes, controlling for preoperative risk via STS predictive risk indices.

Main Results:

  • Included 43,747 patients; 80% received preoperative beta-blockers (ß-blockers).
  • Patients receiving ß-blockers had incrementally lower median STS predicted risk of mortality scores.
  • No significant difference was observed in risk-adjusted mortality, morbidity, length of stay, or hospital readmission between ß-blocker and non-ß-blocker groups.

Conclusions:

  • Preoperative beta-blocker (ß-blocker) use is not associated with risk-adjusted mortality or morbidity after coronary artery bypass grafting (CABG).
  • The study found no significant impact of preoperative ß-blocker use on hospital resource utilization.
  • These findings indicate that routine preoperative ß-blocker administration should not serve as a measure of surgical quality for CABG.
Abstract

Keywords:
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