Anesthesia Experts

Beta-Blockers for Noncardiac Surgery: Helpful for High-Risk Patients, Harmful for Low-Risk Patients

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Perioperative beta-blockade in patients undergoing noncardiac surgery is associated with reduced mortality only in those with three or more risk factors, according to a retrospective study in JAMA Surgery.

Researchers analyzed clinical and administrative data for over 300,000 patients undergoing noncardiac surgery at Veterans Affairs medical centers. Of these, 42% received perioperative beta-blockers. Patients were assessed for four prognostic factors: renal failure, coronary artery disease, diabetes, and surgery in a major body cavity.

Among patients with three or four factors, beta-blocker usage was associated with a 37% reduction in 30-day mortality risk, compared with no beta-blocker use. There was no elevated risk for patients with one or two factors. However, among patients with no factors, beta-blocker use was linked to a 19% increase in mortality risk.

The authors say this is the first study to show increased mortality with perioperative beta-blockade in patients at low cardiac risk.

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