Patterns of ?-blocker initiation in patients undergoing intermediate to high-risk noncardiac surgery.

ABSTRACT:

Background

Based on 2 small randomized controlled trials (RCTs) from the 1990s, ?-blockers were promoted to prevent perioperative cardiac events in patients undergoing noncardiac surgery. In 2008, a large RCT (POISE trial) showed an increased mortality risk associated with perioperative ?-blockade, raising concerns about an extensive ?-Blocker use.

Objectives

The objective of the study is to examine patterns of ?-Blocker initiation among patients undergoing noncardiac elective surgery in the US.

Methods

From a large, nationwide US health care insurer, we identified patients ?18 years old who underwent moderate- to high-risk noncardiac elective surgery between 2003 and 2012 and initiated a ?-Blocker within 30 days before surgery. We evaluated temporal trends and assessed the impact of the POISE trial on perioperative ?-Blocker initiation. We also evaluated patient characteristics and examined the effect of temporal proximity to surgery on the likelihood of ?-Blocker initiation.

Results

Of 499,752 patients undergoing surgery, 9,014 (18 per 1,000 patients) initiated a ?-Blocker. ?-Blocker initiation increased from 12 per 1,000 patients in 2003 to 23 before POISE, after which it decreased to 14 by December 2012 (P = .0001). ?-Blocker initiation remained relatively high among patients undergoing vascular surgery or with Revised Cardiac Risk Index score ? 2. Proximity to surgery was highly predictive of ?-Blocker initiation (odds ratio 3.34, 95% CI 3.17-3.51).

Conclusions

After a period of a rapidly increasing trend, perioperative ?-Blocker initiation decreased sharply in the second half of 2008 and continued to decrease afterwards. ?-Blocker initiation remained relatively high in patients with Revised Cardiac Risk Index score ?2 and in those undergoing major vascular surgery.

SUBMITTER: Patorno E 

PROVIDER: S-EPMC7810354 | biostudies-literature | 2015 Oct

REPOSITORIES: biostudies-literature