Abstract 2951: Do the Benefits of Post-Operative Beta-Blockade Outweigh the Harms in Patients Undergoing Non-Cardiac Surgery?
While studies of post-operative beta-blockers in patients undergoing non-cardiac surgery (NCS) have demonstrated a reduction in patients’ risk for myocardial infarction (MI), more recent studies have suggested they are also associated with greater risks of stroke and mortality. Therefore, we conducted a meta-analysis to evaluate the comparative benefits and harms associated with utilizing post-operative beta-blockers in NCS. We performed a meta-analysis of randomized, double-blinded, placebo-controlled trials evaluating the use of post-operative beta-blockade in previously beta-blocker-naïve patients undergoing NCS. A systematic literature search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials was performed from the earliest possible date through May 2008. The random-effects modeled relative risks (RRs) of experiencing cardiovascular outcomes with beta-blockade compared to placebo are reported with accompanying 95% confidence intervals (CIs). Six trials (n=10,183 subjects) met all inclusion criteria. Upon meta-analysis, post-operative beta-blockade was found to be associated with a statistically significant 25% reduction in a patient’s risk for MI, but also a 97% increased risk for developing a stroke, 38% increased risk of hypotension and a 3-fold increased risk of bradycardia compared to placebo (Table⇓). Statistical heterogeneity was not seen with any of the analyses (I2=0%) with the exception of hypotension (I2=54.6%) and bradycardia (I2=28.8%). While beta-blockade reduces the risk of MI in patients undergoing NCS, some of this benefit is offset by an increased risk of stroke. Additional randomized controlled trials should be undertaken to confirm these findings.