According to the results of research published early online in the Archives of Surgery, beta-blockers should be continued peri-operatively, including on the day of surgery, to avoid cardiac complications.
The authors note that studies to date examining beta-blocker withdrawal have had small sample sizes, have been conducted in a limited number of settings, and have focused on patients undergoing vascular or cardiac procedures. The purpose of their study was to evaluate the relationship among the continuation of beta-blockers, survival, and cardiac complications in elective colorectal and bariatric surgical procedures.
They used data from the Washington's Surgical Care and Outcomes Assessment Program, a prospectively gathered clinical quality improvement activity that is implemented in nearly all hospitals in this state where surgery is performed. Their analysis included 1,976 patients taking beta-blockers before elective colorectal or bariatric surgery in 2008-2009; therapy was continued throughout the peri-operative period in 1,303 (65.9%) but discontinued on the day of surgery and/or postoperatively in 673 (34.1%). The proportion of patients continuing beta-blockers on the day of surgery and postoperatively improved over time, from 57.2% in 2008 to 71.3% in 2009 (p<0.001).
The main outcome measure was a composite of mortality or adverse cardiac events at 90 days. After adjusting for risk characteristics, discontinuation of beta-blockers was associated with an increased risk of the primary outcome (odds ratio [OR] 1.97; 95% CI 1.19-3.26); this risk was still elevated at one year postoperatively (OR 1.66; 95% CI 1.08-2.55). The risk of the composite endpoint at 90 days was higher for those patients with a higher cardiac risk (OR 5.91; 95% CI 1.40-25.00). A secondary analysis showed that stopping beta-blockers on the day of surgery and continuing them in the post-operative period was also associated with an increased risk of the primary endpoint (OR 2.02; 95% CI 1.11-3.68).
The authors suggest that a focus on beta-blocker continuation is a worthwhile quality improvement target and should improve patient outcomes.