β-blockers and risk of all-cause mortality in non-cardiac surgery

Angeli, Fabio; Verdecchia, Paolo; Karthikeyan, Ganesan; Repaci, Salvatore; Pinto, Maurizio Del; Gentile, Giorgio; Cavallini, Claudio; Reboldi, Gianpaolo

doi:10.1177/1753944710361731

Cited by 7 publications

(3 citation statements)

References 55 publications

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“…42,68,70 Some reviewers have suggested that the harm associated with beta-blocker use in the POISE study resulted from an excessive dose. 73 A metaanalysis of studies of beta-blockers by a task force of the American College of Cardiology and the American Heart Association 68 showed, however, that the increased risk of stroke and death was qualitatively unchanged when the POISE data were omitted. Other authors have suggested that it is more appropriate to initiate beta-blockade weeks, instead of hours, before surgery.…”

Section: Interventions Targeting the Stress Responsementioning

confidence: 99%

Cardiac Complications in Patients Undergoing Major Noncardiac Surgery

2015

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lthough major noncardiac surgery has the potential to improve the quality and prolong the duration of a patient's life, surgery may also precipitate complications such as death from cardiac causes, myocardial infarction or injury, cardiac arrest, or congestive heart failure. 1 In this article, we review what is known about the epidemiology and mechanisms of perioperative cardiac complications (i.e., from induction of anesthesia to within 30 days after surgery), preoperative methods of predicting these complications, perioperative cardiac interventions, and postoperative monitoring. Epidemiol ogy a nd Mech a nisms of Per ioper ati v e C a r di ac Complic ations

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Section: Interventions Targeting the Stress Responsementioning

confidence: 99%

Cardiac Complications in Patients Undergoing Major Noncardiac Surgery

2015

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“…Though the current data is insufficient to demonstrate benefits of beta-blockers, the literature suggests that peri-operative beta-blockers provide a benefit which is usually restricted to patients undergoing high-risk surgery. [3910]…”

Section: Discussionmentioning

confidence: 99%

Influence of changing trends in anaesthetic practice on morbidity and mortality in elderly patients undergoing lower limb surgery

2014

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Background and Aims:Several changes in the management protocols of anaesthesia for geriatric patients were introduced into clinical practice to improve the outcome. Very few studies have evaluated the impact of these management protocols. The aim of our study was to evaluate impact of some of the changes in the peri-operative management protocols of geriatric patients undergoing elective orthopaedic lower limb surgeries on the outcomes.Methods:A retrospective chart review of thirty-eight surgical patients from 1999 (Group 1999) before the introduction of changes and 107 patients from 2007 (Group 2007) after establishing changes was performed and data of peri-operative variables were collected and analysed. The primary outcome measured was in-hospital mortality. The secondary outcomes were occurrence of intra-operative and post-operative complications. Comparison of continuous variables between the two groups was performed using independent sample T test and categorical variables using Chi-square test. Multivariate logistic regression was done to identify independent predictors of mortality.Results:The use of beta blockers, deep vein thrombosis prophylaxis with low molecular weight heparin and epidural technique for post-operative analgesia was higher in group 2007. Despite higher prevalence of patients with electrocardiographic changes and anaemia, the incidence of intra-operative or post-operative complications was lower in 2007, though the mortality rate in both the groups was comparable. The independent risk factors for mortality in these geriatric patients were intra-operative hypotension (Odds Ratio (OR) =11.33) and post-operative myocardial ischaemia (OR = 34.5), pulmonary embolism (OR = 17.1) and neurologic changes (OR = 17.1).Conclusions:Implementation of new management practices had significantly reduced the incidence of intra- and post-operative complications.

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“…Potential benefits of the use of beta-blockers after non-cardiac surgery include reduction in post-operative myocardial ischaemia and prevention of arrhythmias 35. One retrospective study involving 1,205 patients with COPD (diagnosed using symptoms and spirometry) undergoing major vascular surgery found that use of cardio-selective beta-blockers was associated with a lower 30-day mortality rate (OR 0.37, 95% CI 0.19 to 0.72) and a reduced longer-term risk of death (hazard ratio [HR] 0.73, 95% CI 0.60 to 0.88).…”

Section: Evidence On Beta-blockers In Copdmentioning

confidence: 99%

Can beta-blockers be used for people with COPD?

2011

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Chronic obstructive pulmonary disease (COPD) is a disabling condition characterised by largely irreversible airflow obstruction, and affects over 3 million people in the UK. Due in large part to shared risk factors--notably smoking--patients with COPD often also have cardiovascular diseases, such as ischaemic heart disease and heart failure. In these conditions, beta-blockers are valuable management options with proven benefits on symptoms and mortality. Historically, however, clinicians have been reluctant to prescribe beta-blockers for patients with co-existing COPD, due to fear of provoking bronchoconstriction. Moreover, such patients have typically been excluded from trials of beta-blockers, raising additional concerns about the basis for treating them with these drugs. However, withholding beta-blocker therapy might lead to suboptimal treatment for cardiovascular disease among these patients. Here we review the efficacy and safety of beta-blockers in patients with COPD.

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β-blockers and risk of all-cause mortality in non-cardiac surgery

Cited by 7 publications

References 55 publications

Cardiac Complications in Patients Undergoing Major Noncardiac Surgery

Cardiac Complications in Patients Undergoing Major Noncardiac Surgery

Influence of changing trends in anaesthetic practice on morbidity and mortality in elderly patients undergoing lower limb surgery

Can beta-blockers be used for people with COPD?

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