Elsevier

American Heart Journal

Volume 141, Issue 1, January 2001, Pages 148-153
American Heart Journal

Surgery
Perioperative β-blocker withdrawal and mortality in vascular surgical patients

Presented as an abstract at the 20th Annual Meeting of the Society of General Internal Medicine, May 1997, and at the 13th International Conference on Pharmacoepidemiology, August 1997.
https://doi.org/10.1067/mhj.2001.111547Get rights and content

Abstract

Objective Our purpose was to determine the effect of postoperative β-blocker withdrawal on mortality and cardiovascular events after vascular surgery. Methods Detailed data were collected on perioperative cardiovascular medication use and discontinuation and cardiovascular risk factors among consecutive major vascular surgical procedures at two university hospitals. Results A total of 140 patients received β-blockers preoperatively. Mortality in the 8 patients who had β-blockers discontinued postoperatively (50%) was significantly greater than in 132 patients who had β-blockers continued (1.5%, odds ratio 65.0, P <.001). The effect of β-blocker discontinuation was unaffected by adjustment by stratification for risk factors (all P ≤.01), for contraindications to restarting β-blockers (P =.006), and by multivariable analyses adjusting for potential confounders (adjusted odds ratio 17.0, P =.01). β-Blocker discontinuation also was associated with increased cardiovascular mortality (0% vs 29%, P =.005) and postoperative myocardial infarction (odds ratio 17.7, P =.003). Conclusion Discontinuing β-blockers immediately after vascular surgery may increase the risk of postoperative cardiovascular morbidity and mortality. (Am Heart J 2001;141:148-53.)

Section snippets

Study population

A list of consecutive vascular surgical patients at a university hospital (University of Pennsylvania Medical Center) between January 1, 1995, and September 30, 1995, was obtained by a computerized search of the medical records system with use of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure codes, which included endarterectomy (38.1), resection of vessel with anastomosis or replacement (38.3, 38.4), other shunt or vascular bypass (39.2),

Prevalence of β-blocker administration and discontinuation

Sixty-one of 222 vascular surgical patients (27%) in the first cohort were receiving β-blockers before surgery. Fifty-five patients had documented use of β-blockers as outpatients and the other 6 received β-blockers in the inpatient preoperative period. β-Blockers were discontinued in 6 (10%) of 61 patients who received β-blockers preoperatively.

All 79 patients in the second cohort received preoperative β-blockers (by design). β-Blockers were discontinued in 2 (2.5%) patients.

Patient demographics and surgery type

Of the 140

Discussion

The results of our study suggest an increased risk of mortality and cardiovascular events associated with β-blocker discontinuation in vascular surgery patients, a group of patients with a relatively high prevalence of coronary artery disease and risk factors for perioperative morbidity and mortality. In evaluating the relationship between inpatient postoperative mortality and β-blocker discontinuation, we have tried to account for potential confounders that may have been associated with

Acknowledgements

We thank Jennifer M. Wolf, MD, and Deborah Carson, RN, BSN, MPH, for their assistance in the collection of data and Ms Sandra Barile for assistance in preparation of this manuscript.

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Reprint requests: Jonathan B. Shammash, MD, Cornell Internal Medicine Associates, New York Presbyterian Hospital–Cornell Medical Center, 1484 First Ave, Second Floor, New York, NY 10021.E-mail: [email protected]

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