Effect of Preoperative Beta-Blocker Use on Outcomes Following Cardiac Surgery

Recent studies suggest that the use of preoperative beta blockers in cardiac surgery may not provide improved mortality rates and may even contribute to negative clinical outcomes. We therefore assessed the role of beta blockers on several outcomes after cardiac surgery (delirium, acute kidney injury [AM], stroke, atrial fibrillation (AF), mortality, and hospital length of stay) in 4,076 patients who underwent elective coronary artery bypass grafting, coronary artery bypass grafting + valve, or valve cardiac surgery from November 1, 2009, to September 30, 2015, at Vanderbilt Medical Center. Clinical data from 2 prospectively collected datasets at our institution were reviewed: the Cardiac Surgery Perioperative Outcomes Database and the Society of Thoracic Surgeons Database. Preoperative (3-blocker use was defined by Society of Thoracic Surgeons guidelines as patients receiving a beta blocker within 24 hours preceding surgery. Of the included patients, 2,648 (65.0%) were administered a beta blocker within 24 hours before surgery. Adjusting for possible confounders, preoperative beta-blocker use was associated with increased odds of AKI stage 2 (odds ratio 1.96, 95% confidence interval 1.19 to 3.24, p <0.01). There was no evidence that beta-blocker use had an independent association with postoperative delirium, AM stages 1 and 3, stroke, AF, mortality, or prolonged length of stay. A secondary, propensity score analysis did not show a marginal association between beta-blocker use and any outcome. In conclusion, we did not find significant evidence that preoperative 0-blocker use was associated with postoperative delirium, AF, AM, stroke, or mortality. (C) 2017 Elsevier Inc. All rights reserved.