Impact of perioperative bleeding on the protective effect of β-blockers during infrarenal aortic reconstruction.

Abstract

BACKGROUND:

The use of β-blockers during the perioperative period remains controversial. Although some studies have demonstrated their protective effects regarding postoperative cardiac complications, others have demonstrated increased mortality when β-blockers were introduced before surgery.

METHODS:

In this observational study involving 1,801 patients undergoing aortic reconstruction, we prospectively assessed β-blocker therapy compared with no β-blocker therapy, with regard to cardiac and noncardiac postoperative outcomes using a propensity score approach. The impact of β-blockers was analyzed according to the intraoperative bleeding estimated by transfusion requirements.

RESULTS:

In-hospital mortality was 2.5% (n=45), β-blocker use was associated with a reduced frequency of postoperative myocardial infarction (OR=0.46, 95% CI [0.26; 0.80]) and myocardial necrosis (OR=0.62, 95% CI [0.43; 0.88]) in all patients, but also with an increased frequency of multiple organ dysfunction syndromes (OR=2.78, 95% CI [1.71; 4.61]). In patients with severe bleeding (n=163; 9.1%), the frequency of in-hospital death (OR=6.65, 95% CI [1.09; 129]) and/or multiple organ dysfunction syndromes (OR=4.18, 95% CI [1.81; 10.38]) were markedly increased. Furthermore, no more than 28% of the patients who died presented with postoperative myocardial infarction, whereas 69% of the patient with a postoperative myocardial infarction also presented an excessive bleeding.

CONCLUSIONS:

Perioperative β-blocker therapy was associated with an overall reduction in postoperative cardiac events. In the vast majority of patients with low perioperative bleeding, the global effect of β-blockers was protective; in contrast, patients given β-blockers who experienced severe bleeding had higher mortality and an increased frequency of multiorgan dysfunction syndrome.

• Authors: Yannick Le Manach, Gary S Collins, Cristina Ibanez, Jean Pierre Goarin, Pierre Coriat, Julien Gaudric, Bruno Riou, Paul Landais
• Journal: Anesthesiology (Anesthesiology) Vol. 117 Issue 6 Pg. 1203-11 (Dec 2012) ISSN: 1528-1175 [Electronic] United States
• PMID: 22652895 (Publication Type: Journal Article)

Chemical References

• Adrenergic beta-Antagonists

Topics

• Acute Kidney Injury (mortality, prevention & control)
• Adrenergic beta-Antagonists (therapeutic use)
• Aged
• Aorta, Abdominal (pathology, surgery)
• Blood Loss, Surgical (mortality, prevention & control)
• Cardiovascular Diseases (mortality, prevention & control)
• Female
• Hospital Mortality (trends)
• Humans
• Male
• Middle Aged
• Percutaneous Coronary Intervention (adverse effects, mortality)
• Perioperative Care (methods, mortality)
• Prospective Studies
• Treatment Outcome