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Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy

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β-Blockade and Operative Mortality in Noncardiac Surgery: Harmful or Helpful?

Mark L Friedell¹, Charles W Van Way¹, Ron W Freyberg²

¹Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City.

|May 29, 2015

Summary

Perioperative beta-blockade benefits high-risk patients undergoing noncardiac surgery (NCS). However, for patients with no cardiac risk factors undergoing NCS, beta-blockers significantly increase the risk of death.

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Area of Science:

Cardiology
Anesthesiology
Pharmacology

Background:

Perioperative beta-blockade use in noncardiac surgery (NCS) is controversial, especially for low-risk patients, due to potential risks like stroke and hypotension.
Previous studies have yielded inconsistent results regarding the benefits of beta-blockade in this population.

Purpose of the Study:

To evaluate the impact of perioperative beta-blockade on mortality in patients undergoing NCS.
Specifically investigate the effect in patients with no pre-existing cardiac risk factors.

Main Methods:

Retrospective observational analysis of 326,489 patients (314,114 undergoing NCS) from Veterans Affairs hospitals (2008-2013).
Beta-blocker administration was recorded from 8 hours pre-surgery to 24 hours post-surgery.
A 4-point cardiac risk score was calculated; 30-day surgical mortality was the primary endpoint.

Main Results:

Beta-blockade significantly reduced mortality (OR, 0.63) in NCS patients with 3-4 cardiac risk factors.
No significant effect was observed in patients with 1-2 risk factors.
Beta-blockade significantly increased mortality (OR, 1.19) in NCS patients with no cardiac risk factors.

Conclusions:

Perioperative beta-blockade is beneficial for patients with high cardiac risk undergoing NCS.
In contrast, beta-blocker use in patients with no cardiac risk factors undergoing NCS is associated with an increased risk of death.