TY - JOUR
T1 - β-blocker continuation after noncardiac surgery
T2 - A report from the Surgical Care and Outcomes Assessment Program
AU - Kwon, Steve
AU - Thompson, Rachel
AU - Florence, Michael
AU - Maier, Ronald
AU - McIntyre, Lisa
AU - Rogers, Terry
AU - Farrohki, Ellen
AU - Whiteford, Mark
AU - Flum, David R.
PY - 2012/5
Y1 - 2012/5
N2 - Background: Despite limited evidence of effect, β-blocker continuation has become a national quality improvement metric. Objective: To determine the effect of β-blocker continuation on outcomes in patients undergoing elective noncardiac surgery. Design, Setting, and Patients: The Surgical Care and Outcomes Assessment Program is aWashington quality improvement benchmarking initiative based on clinical data from more than 55 hospitals. Linking Surgical Care and Outcomes Assessment Program data to Washington's hospital admission and vital status registries, we studied patients undergoing elective colorectal and bariatric surgical procedures at 38 hospitals between January 1, 2008, and December 31, 2009. Main Outcome Measures: Mortality, cardiac events, and the combined adverse event of cardiac events and/or mortality. Results: Of 8431 patients, 23.5% were taking β-blockers prior to surgery (mean [SD] age, 61.9 [13.7] years; 63.0% were women). Treatment with β-blockers was continued on the day of surgery and during the postoperative period in 66.0% of patients. Continuation of β-blockers both on the day of surgery and postoperatively improved from 57.2% in the first quarter of 2008 to 71.3% in the fourth quarter of 2009 (P value <.001). After adjusting for risk characteristics, failure to continue β-blocker treatment was associated with a nearly 2-fold risk of 90-day combined adverse event (odds ratio, 1.97; 95% CI, 1.19-3.26). The odds were even greater among patients with higher cardiac risk (odds ratio, 5.91; 95% CI, 1.40-25.00). The odds of combined adverse events continued to be elevated 1 year postoperatively (odds ratio, 1.66; 95% CI, 1.08-2.55). Conclusions: β-Blocker continuation on the day of and after surgery was associated with fewer cardiac events and lower 90-day mortality. A focus on β-blocker continuation is a worthwhile quality improvement target and should improve patient outcomes.
AB - Background: Despite limited evidence of effect, β-blocker continuation has become a national quality improvement metric. Objective: To determine the effect of β-blocker continuation on outcomes in patients undergoing elective noncardiac surgery. Design, Setting, and Patients: The Surgical Care and Outcomes Assessment Program is aWashington quality improvement benchmarking initiative based on clinical data from more than 55 hospitals. Linking Surgical Care and Outcomes Assessment Program data to Washington's hospital admission and vital status registries, we studied patients undergoing elective colorectal and bariatric surgical procedures at 38 hospitals between January 1, 2008, and December 31, 2009. Main Outcome Measures: Mortality, cardiac events, and the combined adverse event of cardiac events and/or mortality. Results: Of 8431 patients, 23.5% were taking β-blockers prior to surgery (mean [SD] age, 61.9 [13.7] years; 63.0% were women). Treatment with β-blockers was continued on the day of surgery and during the postoperative period in 66.0% of patients. Continuation of β-blockers both on the day of surgery and postoperatively improved from 57.2% in the first quarter of 2008 to 71.3% in the fourth quarter of 2009 (P value <.001). After adjusting for risk characteristics, failure to continue β-blocker treatment was associated with a nearly 2-fold risk of 90-day combined adverse event (odds ratio, 1.97; 95% CI, 1.19-3.26). The odds were even greater among patients with higher cardiac risk (odds ratio, 5.91; 95% CI, 1.40-25.00). The odds of combined adverse events continued to be elevated 1 year postoperatively (odds ratio, 1.66; 95% CI, 1.08-2.55). Conclusions: β-Blocker continuation on the day of and after surgery was associated with fewer cardiac events and lower 90-day mortality. A focus on β-blocker continuation is a worthwhile quality improvement target and should improve patient outcomes.
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U2 - 10.1001/archsurg.2011.1698
DO - 10.1001/archsurg.2011.1698
M3 - Article
C2 - 22249847
AN - SCOPUS:84861406263
VL - 147
SP - 467
EP - 473
JO - JAMA Surgery
JF - JAMA Surgery
SN - 2168-6254
IS - 5
ER -