Perioperative beta-blocker use was significantly protective against combined cardiac outcomes (OR 0.20; 95% CI 0.1-0.6; P=0.004) in patients undergoing liver transplantation surgery.
Cohort (n=403)
What are the perioperative risk predictors of 30-day cardiac outcomes in patients undergoing liver transplantation surgery?
In patients undergoing liver transplantation, history of stroke, coronary artery disease, postoperative sepsis, and increased interventricular septal thickness predict adverse 30-day cardiac outcomes, whereas perioperative beta-blocker use is protective.
Effect estimate: OR 0.20 (95% CI 0.1 to 0.6)
p-value: p=0.004
BACKGROUND: Cardiac risk assessment for perioperative outcomes of liver transplantation patients is limited. We examined the outcomes of an older intermediate-cardiac-risk group of patients undergoing liver transplantation surgery. METHODS AND RESULTS: Patients who had liver transplantation surgery between 2001 and 2005 were studied. The 3 outcomes analyzed were nonfatal myocardial infarction, death, and either outcome within the first 30 days after the liver transplantation surgery. Of 403 patients (mean age, 52+/-9 years; 67% male), 106 (26%) were diabetic, 84 (21%) were hypertensive, and 173 (43%) had a history of smoking. There were 48 total events (12%), 25 myocardial infarctions (7%), and 38 deaths (9%) recorded during the perioperative period. From the final multivariate model, history of coronary artery disease, prior stroke, and postoperative sepsis predicted greater risk (P=0.014; odds ratio OR, 4.0; 95% confidence interval CI, 1.3 to 11.8; P=0.025; OR, 6.6; 95% CI, 1.3 to 33.8; and P<0.001; OR, 7.5; 95% CI, 3.3 to 17.1, respectively). Use of perioperative beta-blockers was protective (P=0.004; OR, 0.20; 95% CI, 0.1 to 0.6) for combined cardiac outcomes. For the outcome of death on multivariate analysis, postoperative sepsis and increased interventricular septal thickness predicted risk (P<0.001; OR, 8.6; 95% CI, 3.5 to 20.9; and P=0.027; OR, 2.8; 95% CI, 1.1 to 7.2, respectively), whereas the use of perioperative beta-blockers was again protective (P=0.012; OR, 0.07; 95% CI, 0.01 to 0.56). CONCLUSIONS: In our study of cardiac risk assessment for liver transplantation surgery, history of stroke, coronary artery disease, postoperative sepsis, and increased interventricular septal thickness were markers of adverse perioperative cardiac outcomes, whereas use of perioperative beta-blockers was significantly protective.
Safadi et al. (Mon,) conducted a cohort in Liver transplantation surgery (n=403). Perioperative beta-blockers and clinical risk factors was evaluated on Combined cardiac outcomes (nonfatal myocardial infarction or death within 30 days) (OR 0.20, 95% CI 0.1 to 0.6, p=0.004). Perioperative beta-blocker use was significantly protective against combined cardiac outcomes (OR 0.20; 95% CI 0.1-0.6; P=0.004) in patients undergoing liver transplantation surgery.