Perioperative Beta-Blocker Therapy and Mortality

lipanz · medicine forum addict Joined: 19 Jun 2005 Posts: 62

Perioperative Beta-Blocker Therapy and Mortality

To the Editor: The large observational study by Lindenauer et al. (July
28 issue)1 seems to confirm that the administration of beta-blockers
improves the postoperative outcome of very high-risk patients
undergoing major surgery. Owing to the nonrandomized design of the
study, the authors cannot exclude the possibility that other
cardioprotective strategies - including prolonged monitoring,
aggressive pain control and rehabilitation, intensive insulin therapy,
and continuation of lipid-lowering agents - could have been used more
frequently or adequately for the patients at highest risk.2,3

On the other hand, the potential harmful effects of beta-blockers raise
several questions, including why almost 20 percent of patients at "no
risk" or low risk received such medications perioperatively.

Since no data on the cardiac or noncardiac causes of in-hospital
mortality are available, we should consider that inappropriate use of
beta-blockers can be associated with serious adverse effects, including
reduced delivery of oxygen to tissue, which could lead to postoperative
organ failure and death.
Such a hypothesis is supported by the results of numerous randomized
trials indicating that perioperative optimization of oxygen delivery
significantly reduces mortality and morbidity among high-risk surgical
patients.4,5

Benoit Vandenbunder, M.D.
Alexandre Mignon, M.D., Ph.D.
Hôpital Cochin, Assistance Publique-Hôpitaux de Paris
75014 Paris, France

alexandre.mignon@cch.aphp.fr References
Lindenauer PK, Pekow P, Wang K, Mamidi DK, Gutierrez B, Benjamin EM.
Perioperative beta-blocker therapy and mortality after major noncardiac
surgery. N Engl J Med 2005;353:349-361. [Abstract/Full Text]
Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin
therapy in critically ill patients. N Engl J Med 2001;345:1359-67.
[Abstract/Full Text]
Lindenauer PK, Pekow P, Wang K, Gutierrez B, Benjamin EM.
Lipid-lowering therapy and in-hospital mortality following major
noncardiac surgery. JAMA 2004;291:2092-2099. [Abstract/Full Text]
Boyd O, Grounds RM, Bennett ED. A randomized clinical trial of the
effect of deliberate perioperative increase of oxygen delivery on
mortality in high-risk surgical patients. JAMA 1993;270:2699-2707.
[Abstract]
Davies SJ, Wilson RJT. Preoperative optimization of the high-risk
surgical patient. Br J Anaesth 2004;93:121-128. [Abstract/Full Text]

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