More Evidence That Perioperative Beta-Blockers in Noncardiac Surgery Can Be Harmful

HYPOTHESIS: We hypothesized that the relationship among beta-blocker use, heart rate control, and perioperative cardiovascular outcome would be similar in patients at all levels of cardiac risk. DESIGN: Retrospective cohort study. SETTING: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas. PATIENTS: Among all patients who underwent various noncardiac surgical procedures in 2000, those who received perioperative beta-blockers were matched and compared with a control group from the same patient population. MAIN OUTCOME MEASURES: Thirty-day stroke, cardiac arrest, myocardial infarction, and mortality, as well as mortality at 1 year. RESULTS: Patients at all levels of cardiac risk who received beta-blockers had lower preoperative and intraoperative heart rates. The beta-blocker group had higher rates of 30-day myocardial infarction (2.94% vs 0.74%, P =.03) and 30-day mortality (2.52% vs 0.25%, P =.007) compared with the control group. In the beta-blocker group, patients who died perioperatively had significantly higher preoperative heart rate (86 vs 70 beats/min, P =.03). None of the deaths occurred among the patients at high cardiac risk. CONCLUSION: Among patients at all levels of cardiac risk undergoing noncardiac surgery, administration of beta-blockers should achieve adequate heart rate control and should be carefully monitored in patients who are not at high cardiac risk. Arch Surg. 2008 Oct;143(10):940-4; discussion 944.