Journal Article

Perioperative β blockers in patients having non-cardiac surgery: a meta-analysis

Gluud, Christian, Pranesh, Shruthi, Sawhney, Sabrina, Bangalore, Sripal, Wetterslev, Jørn, Messerli, Franz H

2008

Overview

American College of Cardiology and American Heart Association (ACC/AHA) guidelines on perioperative assessment recommend perioperative β blockers for non-cardiac surgery, although results of some clinical trials seem not to support this recommendation. We aimed to critically review the evidence to assess the use of perioperative β blockers in patients having non-cardiac surgery. We searched Pubmed and Embase for randomised controlled trials investigating the use of β blockers in non-cardiac surgery. We extracted data for 30-day all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction, non-fatal stroke, heart failure, and myocardial ischaemia, safety outcomes of perioperative bradycardia, hypotension, and bronchospasm. 33 trials included 12 306 patients. β blockers were not associated with any significant reduction in the risk of all-cause mortality, cardiovascular mortality, or heart failure, but were associated with a decrease (odds ratio [OR] 0·65, 95% CI 0·54–0·79) in non-fatal myocardial infarction (number needed to treat [NNT] 63) and decrease (OR 0·36, 0·26–0·50) in myocardial ischaemia (NNT 16) at the expense of an increase (OR 2·01, 1·27–3·68) in non-fatal strokes (number needed to harm [NNH] 293). The beneficial effects were driven mainly by trials with high risk of bias. For the safety outcomes, β blockers were associated with a high risk of perioperative bradycardia requiring treatment (NNH 22), and perioperative hypotension requiring treatment (NNH 17). We recorded no increased risk of bronchospasm. Evidence does not support the use of β-blocker therapy for the prevention of perioperative clinical outcomes in patients having non-cardiac surgery. The ACC/AHA guidelines committee should soften their advocacy for this intervention until conclusive evidence is available. None.

• Publisher: Elsevier Ltd
• Subject: Adrenergic beta-Antagonists - pharmacology / Adrenergic beta-Antagonists - therapeutic use / Cardiovascular Diseases - mortality / Cardiovascular Diseases - prevention & control / Hemodynamics - drug effects / Humans / Internal Medicine / Intraoperative Care / Intraoperative Complications - mortality / Intraoperative Complications - prevention & control / Randomized Controlled Trials as Topic