Perioperative β-blocker therapy has been associated with increased risk of stroke. However, the association between β-blocker initiation before the day of surgery and the risk of stroke is unknown. The authors hypothesized there would be no association between preoperative β-blocker initiation within 60 days of surgery or chronic β-blockade (more than 60 days) and the risk of stroke in patients undergoing major abdominal surgery.
Data on elective major abdominal surgery were obtained from the IBM (USA) Truven Health MarketScan 2005 to 2015 Commercial and Medicare Supplemental Databases. Patients were stratified by β-blocker dispensing exposure: (1) β-blocker–naïve, (2) preoperative β-blocker initiation within 60 days of surgery, and (3) chronic β-blocker dispensing (more than 60 days). The authors compared in-hospital stroke and major adverse cardiac events between the different β-blocker therapy exposures.
There were 204,981 patients who underwent major abdominal surgery. β-Blocker exposure was as follows: perioperative initiation within 60 days of surgery for 4,026 (2.0%) patients, chronic β-blocker therapy for 45,424 (22.2%) patients, and β-blocker–naïve for 155,531 (75.9%) patients. The unadjusted frequency of stroke for patients with β-blocker initiation (0.4%, 17 of 4,026) and chronic β-blocker therapy (0.4%, 171 of 45,424) was greater than in β-blocker–naïve patients (0.2%, 235 of 155,531; P < 0.001). After propensity score weighting, patients initiated on a β-blocker within 60 days of surgery (odds ratio, 0.90; 95% CI, 0.31 to 2.04; P = 0.757) or on chronic β-blocker therapy (odds ratio, 0.86; 95% CI, 0.65 to 1.15; P = 0.901) demonstrated similar stroke risk compared to β-blocker–naïve patients. Patients on chronic β-blocker therapy demonstrated lower adjusted risk of major adverse cardiac events compared to β-blocker–naïve patients (odds ratio, 0.81; 95% CI, 0.72 to 0.91; P = 0.007), despite higher unadjusted absolute event rate (2.6% [1,173 of 45,424] vs. 0.6% [872 of 155,531]).
Among patients undergoing elective major abdominal surgery, the authors observed no association between preoperative β-blocker initiation within 60 days of surgery or chronic β-blocker therapy and stroke.
- Controversy surrounds the initiation of perioperative β-blockade to reduce the risk of major adverse cardiac events for patients undergoing major noncardiac surgery
- Clinicians are unclear whether the cardiovascular benefit of β-blockade observed in clinical trials is counterbalanced by an increased risk of stroke
- Using national administrative claims data for adults undergoing elective major abdominal surgery, patients initiating β-blocker therapy within 60 days before surgery were compared to patients on chronic β-blocker therapy and β-blocker–naïve patients
- Postoperative stroke was rare: 0.4% (17 of 4,026) of patients initiating a β-blocker, 0.4% (171 of 45,424) on chronic β-blockers, and 0.2% (235 of 155,531) of β-blocker–naïve patients
- After propensity score weighting, patients initiated on a β-blocker (odds ratio, 0.90; 95% CI, 0.31 to 2.04) or on chronic β-blocker therapy (odds ratio, 0.86; 95% CI, 0.65 to 1.15) demonstrated stroke risk similar to β-blocker–naïve patients