Abstract 14532: Duration of Preoperative Beta-Blocker Therapy and Outcomes after Non-Cardiac Surgery
INTRODUCTION: Clinical practice guidelines recommend that perioperative beta-blockade be initiated several days to weeks before non-cardiac surgery. However, the minimum required period of preoperative beta-blocker therapy is unclear.
METHODS: Following REB approval, we used population-based administrative databases to conduct a cohort study of 48,013 patients who were aged ≥66 years, underwent major elective non-cardiac surgery in Ontario, Canada between 2003 and 2009, and received preoperative beta-blocker therapy. Multivariable logistic regression was used to determine the association between the duration of beta-blocker treatment before surgery (categorized as 1 to 7 days, 8 to 30 days, and ≥31 days) and 30-day mortality, 30-day myocardial infarction, and 1-year mortality.
RESULTS: Of the cohort, 2.3% (n=1105) started beta-blockers 1 to 7 days before surgery, 5.5% (n=2639) started 8 to 30 days before surgery, and 92.0% (n=44,269) started 31 or more days before surgery. Compared to beta-blocker initiation 31 or more days before surgery, initiation 1 to 7 days before surgery was associated with significantly increased 30-day mortality (odds ratio [OR] OR 1.49; 95% CI, 1.03 to 2.16; P=0.03) whereas initiation 8 to 30 days before surgery was not (OR 0.95; CI, 0.69 to 1.31; P=0.77). Initiation 1 to 7 days before surgery was not significantly associated with 1-year mortality (OR 1.06; CI, 0.84 to 1.35; P=0.62) or 30-day myocardial infarction (OR 1.26, CI, 0.92 to 1.71; P=0.15). The results were qualitatively unchanged when the analyses were repeated in subgroups receiving only long-acting beta-blocker formulations vs. other formulations. The relationship between duration of beta-blocker treatment and 30-day mortality remained similar if treatment duration was modeled using restricted cubic splines (Figure).
CONCLUSIONS: For cases where perioperative beta-blockade is warranted, therapy should likely be initiated at least 1 week before elective surgery.
- © 2012 by American Heart Association, Inc.