Key result
Discontinuation of beta-blocker prescription during the first week after arthroplasty was significantly associated with postoperative myocardial infarction (OR 2.0; 95% CI 1.1-3.9).
Why the study?
Does discontinuation of perioperative beta-blocker therapy increase the risk of postoperative myocardial infarction and death in low-risk patients undergoing elective hip or knee arthroplasty?
Cohort (n=5,158)
Does discontinuation of perioperative beta-blocker therapy increase the risk of postoperative myocardial infarction and death in low-risk patients undergoing elective hip or knee arthroplasty?
Odds Ratio: 2 (95% CI 1.1–3.9)
Discontinuation of beta-blocker therapy during the first week after elective hip or knee arthroplasty is associated with a twofold increased risk of postoperative myocardial infarction and death.
Beta-blocker discontinuation after arthroplasty was associated with higher postoperative MI risk; leaves open whether continuation improves outcomes in low-risk elective patients.
BACKGROUND: American College of Cardiology/American Heart Association guidelines recommend beta-blockade for selected low- and intermediate-risk noncardiac surgery patients. The authors evaluated the effect of perioperative beta-blockade on postoperative myocardial infarction (POMI) in low-risk patients undergoing intermediate-risk surgery. METHODS: Patients who underwent elective hip or knee arthroplasty between January 1, 2002 and June 30, 2006 were identified. POMI was defined as a Troponin T value of more than 0.1 ng . ml(-1). Patients were divided into three groups: those prescribed a beta-blocker on the day of surgery and throughout their hospital stay (or 7 days, whichever came first), those prescribed a beta-blocker on the day of surgery but discontinued during the first 7 days, and those not prescribed a beta-blocker on the day of surgery. Propensity analysis and logistic regression were used to determine the independent association of beta-blocker exposure on POMI. RESULTS: Of the 5,158 arthroplasty patients, 992 (18%) were treated with beta-blockers on the day of surgery. This beta-blocker was discontinued in 252 patients (25%). POMI occurred in 77 patients (1.5%). Discontinuation of beta-blocker prescription was significantly associated with POMI (odds ratio 2.0; 95% CI 1.1-3.9) and death (odds ratio 2.0; 95% CI 1.0-3.9). CONCLUSION: After adjustment for confounders, discontinuation of beta-blocker prescription during the first week after surgery was significantly associated with POMI and death. These findings confirm the American College of Cardiology/American Heart Association Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery, which recommend not to withdraw beta-blocker therapy.
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Klei et al. (2009) conducted a cohort in elective hip or knee arthroplasty (n=5,158). Discontinuation of beta-blocker prescription vs. Continuation of beta-blocker prescription was evaluated on postoperative myocardial infarction (POMI) (OR 2.0, 95% CI 1.1-3.9). Discontinuation of beta-blocker prescription during the first week after arthroplasty was significantly associated with postoperative myocardial infarction (OR 2.0; 95% CI 1.1-3.9).
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