Needs analysis for the development of a preoperative clinic protocol for perioperative beta-blocker therapy

Hepner, David L.; Correll, Darin; Beckman, Joshua A.; Klickovich, Robert J.; Park, Kenneth H.; Govindarajulu, Usha; Bader, Angela M.

doi:10.1016/j.jclinane.2008.06.007

Cited by 6 publications

(2 citation statements)

References 30 publications

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“…In patients undergoing emergency orthopedic surgery, the number of major cardiac events is more than 10% [ 14 ]. Data suggest that beta-blockade is underused in noncardiac surgery [ 15 ] and that it has a prophylactic role in preventing postoperative adverse events, particularly cardiovascular deaths [ 10 , 11 ]. There is a distinct gap in the literature concerning the use of beta-adrenergic blockade in patients undergoing orthopedic surgery for proximal femur fractures.…”

Section: Introductionmentioning

confidence: 99%

A nationwide observational cohort study of the relationship between beta-blockade and survival after hip fracture surgery

Ahl

Ismail

Borg

et al. 2021

Eur J Trauma Emerg Surg

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Purpose Despite advances in the care of hip fractures, this area of surgery is associated with high postoperative mortality. Downregulating circulating catecholamines, released as a response to traumatic injury and surgical trauma, is believed to reduce the risk of death in noncardiac surgical patients. This effect has not been studied in hip fractures. This study aims to assess whether survival benefits are gained by reducing the effects of the hyper-adrenergic state with beta-blocker therapy in patients undergoing emergency hip fracture surgery. Methods This is a retrospective nationwide observational cohort study. All adults $$\ge$$ ≥ 18 years were identified from the prospectively collected national quality register for hip fractures in Sweden during a 10-year period. Pathological fractures were excluded. The cohort was subdivided into beta-blocker users and non-users. Poisson regression with robust standard errors and adjustments for confounders was used to evaluate 30-day mortality. Results 134,915 patients were included of whom 38.9% had ongoing beta-blocker therapy at the time of surgery. Beta-blocker users were significantly older and less fit for surgery. Crude 30-day all-cause mortality was significantly increased in non-users (10.0% versus 3.7%, p < 0.001). Beta-blocker therapy resulted in a 72% relative risk reduction in 30-day all-cause mortality (incidence rate ratio 0.28, 95% CI 0.26–0.29, p < 0.001) and was independently associated with a reduction in deaths of cardiovascular, respiratory, and cerebrovascular origin and deaths due to sepsis or multiorgan failure. Conclusions Beta-blockers are associated with significant survival benefits when undergoing emergency hip fracture surgery. Outlined results strongly encourage an interventional design to validate the observed relationship.

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Section: Introductionmentioning

confidence: 99%

A nationwide observational cohort study of the relationship between beta-blockade and survival after hip fracture surgery

Ahl

Ismail

Borg

et al. 2021

Eur J Trauma Emerg Surg

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“…BB therapy remains significantly underused for a large proportion of surgical patients. 38 With the evidence currently available, it is not possible to recommend initiating BB therapy in BB naive patients; however, the aspiration is that this study will provide further evidence for the imperative nature of investigating this possibility using an interventional study design. These findings also lend further credence to considering factors other than surgical variables when managing hip fracture patients.…”

Section: Discussionmentioning

confidence: 95%

Beta-Blocker Therapy Is Associated With Increased 1-Year Survival After Hip Fracture Surgery: A Retrospective Cohort Study

Ismail

Ahl

Forssten

et al. 2021

Anesthesia &Amp; Analgesia

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BACKGROUND: The high mortality rates seen within the first postoperative year after hip fracture surgery have remained relatively unchanged in many countries for the past 15 years. Recent investigations have shown an association between beta-blocker (BB) therapy and a reduction in risk-adjusted mortality within the first 90 days after hip fracture surgery. We hypothesized that preoperative, and continuous postoperative, BB therapy may also be associated with a decrease in mortality within the first year after hip fracture surgery. METHODS: In this retrospective cohort study, all adults who underwent primary emergency hip fracture surgery in Sweden, between January 1, 2008 and December 31, 2017, were included. Patients with pathological fractures and conservatively managed hip fractures were excluded. Patients who filled a prescription within the year before and after surgery were defined as having ongoing BB therapy. The primary outcome of interest was postoperative mortality within the first year. To reduce the effects of confounding from covariates due to nonrandomization in the current study, the inverse probability of treatment weighting (IPTW) method was used. Subsequently, Cox proportional hazards models were fitted to the weighted cohorts. These analyses were repeated while excluding patients who died within the first 30 days postoperatively. This reduces the effect of early deaths due to surgical and anesthesiologic complications as well as the higher degree of advanced directives present in the study population compared to the general population, which allowed for the evaluation of the long-term association between BB therapy and mortality in isolation. Results are reported as hazard ratios (HR) with 95% confidence intervals (CI). Statistical significance was defined as a 2-sided P value <.05. RESULTS: A total of 134,915 cases were included in the study. After IPTW, BB therapy was associated with a 42% reduction the risk of mortality within the first postoperative year (adjusted HR = 0.58, 95% CI, 0.57–0.60; P < .001). After excluding patients who died within the first 30 days postoperatively, BB therapy was associated with a 27% reduction in the risk of mortality (adjusted HR = 0.73, 95% CI, 0.71–0.75; P < .001). CONCLUSIONS: A significant reduction in the risk of mortality in the first year following hip fracture surgery was observed in patients with ongoing BB therapy. Further investigations into this finding are warranted.

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Perioperative Use of β-Blockers in the Elderly Patient

Lombaard

Robbertze

2009

Anesthesiology Clinics

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Needs analysis for the development of a preoperative clinic protocol for perioperative beta-blocker therapy

Cited by 6 publications

References 30 publications

A nationwide observational cohort study of the relationship between beta-blockade and survival after hip fracture surgery

A nationwide observational cohort study of the relationship between beta-blockade and survival after hip fracture surgery

Beta-Blocker Therapy Is Associated With Increased 1-Year Survival After Hip Fracture Surgery: A Retrospective Cohort Study

Perioperative Use of β-Blockers in the Elderly Patient

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