Dataset Information

Perioperative beta-blockers for preventing surgery-related mortality and morbidity in adults undergoing non-cardiac surgery.

ABSTRACT:

SUBMITTER: Blessberger H

PROVIDER: S-EPMC6761481 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Perioperative beta-blockers for preventing surgery-related mortality and morbidity in adults undergoing non-cardiac surgery.

Blessberger Hermann H Lewis Sharon R SR Pritchard Michael W MW Fawcett Lizzy J LJ Domanovits Hans H Schlager Oliver O Wildner Brigitte B Kammler Juergen J Steinwender Clemens C

The Cochrane database of systematic reviews 20190926

<h4>Background</h4>Randomized controlled trials (RCTs) have yielded conflicting results regarding the ability of beta-blockers to influence perioperative cardiovascular morbidity and mortality. Thus routine prescription of these drugs in an unselected population remains a controversial issue. A previous version of this review assessing the effectiveness of perioperative beta-blockers in cardiac and non-cardiac surgery was last published in 2018. The previous review has now been split into two re ...[more]

PMID: 31556094

Similar Datasets

Project description:Background Renin-angiotensin system blockers (RASBs) have well-validated benefit in patients with hypertension, coronary artery disease, and left ventricular systolic dysfunction. Their use in the perioperative period, however, has been controversial, including in patients undergoing cardiac surgery, who often have a strong indication for their use. In the current study, we explore the impact of RASB use with 30-day and 1-year mortality after cardiac surgery. Methods and Results The Veterans Affairs Surgical Quality Improvement Program and Corporate Data Warehouse were data sources for this retrospective cohort study. A total of 37 197 veterans undergoing elective coronary artery bypass grafting and or valve repair or replacement over a 10-year period met inclusion criteria and were stratified into 4 groups by preoperative exposure (preoperative exposure versus no preoperative exposure) and postoperative continuing exposure (current exposure versus no current exposure) to RASBs. After adjusting for all baseline covariates, the preoperative exposure/current exposure group had lower 30-day and 1-year mortality than the preoperative exposure/no current exposure (30-day hazard ratio [HR], 0.25; 95% CI, 0.19-0.33 [P<0.001] and 1-year HR, 0.40; 95% CI, 0.33-0.48 [P<0.001] or no preoperative exposure/no current exposure (30-day HR, 0.44; 95% CI, 0.32-0.60 [P<0.001] and 1-year HR, 0.72; 95% CI, 0.62-0.84 [P<0.001] groups. The no preoperative exposure/current exposure group had significantly lower 30-day (HR, 0.31; 95% CI, 0.14-0.71 [P=0.006]) and 1-year (HR, 0.64; 95% CI, 0.53-0.77 [P<0.001]) mortality than the no preoperative exposure/no current exposure group. Conclusions Continuation of preoperative RASBs and initiation before discharge is associated with decreased mortality in veterans undergoing cardiac surgery. Given these findings, continuation of preoperative RASBs or initiation in the early postoperative period should be considered in patients undergoing cardiac surgery.

Project description:Background Perioperative cardiac arrest (PCA) in non-cardiac surgery patients is a rare but potentially catastrophic event with high mortality. Several studies highlighted factors contributing to PCA within the surgical population, but information on its outcomes remains limited. This study sought to identify independent factors associated with 30-day mortality after PCA in adults undergoing non-cardiac surgery. Methods A retrospective cohort study was performed to identify these factors, PCA incidence, and incidence of 30-day mortality in non-cardiac surgery patients between 2015 to 2021 at Siriraj Hospital. Data collection entailed patient characteristics, surgical and anesthetic procedures, cardiac arrest details, and outcomes. Univariable and multivariable logistic regression analyses were performed to identify risk factors. Results One hundred and five PCA cases from the Siriraj Hospital database were assessed from 259,372 anesthesia cases. Independent risk factors significantly associated with 30-day mortality included: preoperative vasopressor use [adjusted relative risk (aRR) 1.90, 95% CI: 1.08–3.32, P=0.025], cardiopulmonary resuscitation (CPR) outside a monitored setting (aRR 1.85, 95% CI: 1.08–3.17, P=0.025), and administering CPR for >15 minutes (aRR 1.97, 95% CI: 1.08–3.57, P=0.027). Univariable analysis found that a physical status classification of four to five by the American Society of Anesthesiologists and use of emergency procedures were also associated with 30-day mortality after PCA. Subgroup analysis revealed that in the emergency group, CPR durations >15 minutes were significantly associated with increased 30-day mortality (aRR 2.05, 95% CI: 1.29–3.28, P=0.003). Overall incidences of PCA and 30-day mortality after PCA were 4.31 per 10,000 and 2.00 per 10,000 cases, respectively. The one-year mortality rate for patients who experienced PCA was 67.6%. The most common cause was hypovolemia (18.1%), followed by acute coronary syndrome (13.3%). Conclusions Preoperative vasopressor use was a pre-arrest contributing factor to 30-day mortality after PCA. Performing CPR outside a monitored setting and administering CPR for >15 minutes were two intra-arrest factors strongly linked to decreased survivability. While these factors are difficult to modify, vigilant monitoring of high-risk patients before PCA occurs and early detection of PCA, along with prompt and aggressive intervention, may improve patient outcomes.

Dataset Information

Perioperative beta-blockers for preventing surgery-related mortality and morbidity in adults undergoing non-cardiac surgery.

Publications

Perioperative beta-blockers for preventing surgery-related mortality and morbidity in adults undergoing non-cardiac surgery.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets