Effect of beta-blocker prescription on the incidence of postoperative myocardial infarction after hip and knee arthroplasty

Anesthesiology. 2009 Oct;111(4):717-24. doi: 10.1097/ALN.0b013e3181b6a761.

Abstract

Background: American College of Cardiology/American Heart Association guidelines recommend beta-blockade for selected low- and intermediate-risk noncardiac surgery patients. The authors evaluated the effect of perioperative beta-blockade on postoperative myocardial infarction (POMI) in low-risk patients undergoing intermediate-risk surgery.

Methods: Patients who underwent elective hip or knee arthroplasty between January 1, 2002 and June 30, 2006 were identified. POMI was defined as a Troponin T value of more than 0.1 ng . ml(-1). Patients were divided into three groups: those prescribed a beta-blocker on the day of surgery and throughout their hospital stay (or 7 days, whichever came first), those prescribed a beta-blocker on the day of surgery but discontinued during the first 7 days, and those not prescribed a beta-blocker on the day of surgery. Propensity analysis and logistic regression were used to determine the independent association of beta-blocker exposure on POMI.

Results: Of the 5,158 arthroplasty patients, 992 (18%) were treated with beta-blockers on the day of surgery. This beta-blocker was discontinued in 252 patients (25%). POMI occurred in 77 patients (1.5%). Discontinuation of beta-blocker prescription was significantly associated with POMI (odds ratio 2.0; 95% CI 1.1-3.9) and death (odds ratio 2.0; 95% CI 1.0-3.9).

Conclusion: After adjustment for confounders, discontinuation of beta-blocker prescription during the first week after surgery was significantly associated with POMI and death. These findings confirm the American College of Cardiology/American Heart Association Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery, which recommend not to withdraw beta-blocker therapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / adverse effects*
  • Adrenergic beta-Antagonists / therapeutic use
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Hip*
  • Arthroplasty, Replacement, Knee*
  • Cohort Studies
  • Data Interpretation, Statistical
  • Female
  • Hemoglobins / metabolism
  • Humans
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Middle Aged
  • Myocardial Infarction / chemically induced*
  • Myocardial Infarction / epidemiology*
  • Myocardial Infarction / mortality
  • Perioperative Care
  • Postoperative Complications / chemically induced*
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / mortality
  • Risk Assessment
  • Survival Analysis
  • Treatment Outcome
  • United States / epidemiology

Substances

  • Adrenergic beta-Antagonists
  • Hemoglobins