Routine β-Blockade in Vascular Surgery

We have evaluated the safety and efficacy of routine β-blockade for the prevention of cardiac complications in a comprehensive series of patients undergoing major vascular surgery and amputation for atherosclerotic arterial disease. From 1 December 2001 to 31 May 2002, patients received perioperative β-blockade by atenolol. Outcomes in this period were compared to the immediately antecedent 6 months. The main outcome measure was the occurrence of cardiac complications. Fifty-three patients underwent surgery in the first period and 54 in the second. After introduction of routine β-blockade, only one patient suffered cardiac complications compared to 10 in the first period ( P = 0.01). There were eight deaths in the first and two in the second period ( P = 0.052). On multivariate analysis, treatment with β-blockers was the only variable significantly associated with a decrease in cardiac morbidity (OR = 0.12; 95% Cl = 0.002–0.66; P = 0.014). Two patients suffered bronchospasm leading to discontinuation of atenolol. Routine perioperative β-blockade was safe and reduced the occurrence of cardiac complications after vascular surgery.