β-blocker continuation after noncardiac surgery: a report from the surgical care and outcomes assessment program

Abstract

Background: Despite limited evidence of effect, β-blocker continuation has become a national quality improvement metric.

Objective: To determine the effect of β-blocker continuation on outcomes in patients undergoing elective noncardiac surgery.

Design, setting, and patients: The Surgical Care and Outcomes Assessment Program is a Washington quality improvement benchmarking initiative based on clinical data from more than 55 hospitals. Linking Surgical Care and Outcomes Assessment Program data to Washington's hospital admission and vital status registries, we studied patients undergoing elective colorectal and bariatric surgical procedures at 38 hospitals between January 1, 2008, and December 31, 2009.

Main outcome measures: Mortality, cardiac events, and the combined adverse event of cardiac events and/or mortality.

Results: Of 8431 patients, 23.5% were taking β-blockers prior to surgery (mean [SD] age, 61.9 [13.7] years; 63.0% were women). Treatment with β-blockers was continued on the day of surgery and during the postoperative period in 66.0% of patients. Continuation of β-blockers both on the day of surgery and postoperatively improved from 57.2% in the first quarter of 2008 to 71.3% in the fourth quarter of 2009 (P value <.001). After adjusting for risk characteristics, failure to continue β-blocker treatment was associated with a nearly 2-fold risk of 90-day combined adverse event (odds ratio, 1.97; 95% CI, 1.19-3.26). The odds were even greater among patients with higher cardiac risk (odds ratio, 5.91; 95% CI, 1.40- 25.00). The odds of combined adverse events continued to be elevated 1 year postoperatively (odds ratio, 1.66; 95% CI, 1.08-2.55).

Conclusions: β-Blocker continuation on the day of and after surgery was associated with fewer cardiac events and lower 90-day mortality. A focus on β-blocker continuation is a worthwhile quality improvement target and should improve patient outcomes.

Figure

Trend of β-blocker continuation over sequential quarters from the first quarter of 2008 (labeled 0) to the fourth quarter of 2009 (labeled 7). Solid line indicates the rate of β-blocker continuation throughout the perioperative period and dashed line, the rate of β-blocker continuation in the postoperative period (Surgical Care and Outcomes Assessment Program metric).