Key result
Perioperative beta-blocker exposure was associated with reduced 30-day all-cause mortality (RR 0.83; 95% CI 0.72-0.96) following non-cardiac surgery, but not with 30-day MACE or stroke risk.
Why the study?
It remained uncertain whether perioperative beta-blocker use provides a benefit on outcomes following non-cardiac surgery.
Does perioperative beta-blocker exposure reduce 30-day all-cause mortality in patients undergoing non-cardiac surgery?
Meta-Analysis (n=1,711,766)
Does perioperative beta-blocker exposure reduce 30-day all-cause mortality in patients undergoing non-cardiac surgery?
Relative Risk: 0.83 (95% CI 0.72–0.96)
Perioperative beta-blocker exposure in non-cardiac surgery is associated with reduced 30-day mortality overall, but increases mortality risk in patients without cardiac risk factors.
May support selective perioperative beta-blocker use in non-cardiac surgery; leaves open RCT confirmation and effects in patients without cardiac risk factors.
BACKGROUND: It remains uncertain whether there is a benefit to perioperative beta-blocker use on outcomes after non-cardiac surgery. This meta-analysis aims to update the evidence regarding the associations between beta-blocker exposure and patient major short-term outcomes following non-cardiac surgery. METHODS: Pubmed, Embase, and the Cochrane Central Register from their inception to May 2019 were searched by two independent authors. Observational studies reporting associations between perioperative beta-blocker treatment and short-term outcomes including 30-day all-cause mortality (ACM), 30-day major adverse cardiovascular events (MACE) and 30-day stroke risk were selected for inclusion. Meta-analyses were carried out by using random effects models. RESULTS: Nineteen studies with a total of 1,711,766 participants were identified. Beta-blocker exposure was associated with reduced 30-day all-cause mortality (ACM) (RR 0.83, 95% CI 0.72 to 0.96). No evidence of publication bias was observed. Subgroup analyses revealed that significant 30-day survival benefits were observed in prospective, population-based studies, drug exposure period last till 1-2 months after surgery, patients having abdominal gastrointestinal surgery or having 3-4 cardiac risk factors. Beta-blocker exposure was associated with increased 30-day ACM among patients with no cardiac risk factors (RR 1.30, 95% CI 1.19 to 1.43). However, meta-analysis demonstrated a non-significant risk reduction in 30-day MACE (RR 1.03; 95% CI 0.85 to 1.25) or 30-day stroke risk (RR 0.86; 95% CI 0.44 to 1.68) with beta-blocker exposure. CONCLUSIONS: The results of the current meta-analysis indicate beta-blocker exposure may be a significant indicator for 30-day ACM, but not for 30-day MACE or 30-day stroke risk. The association between beta-blocker exposure and long-term outcomes deserves further investigation.
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Yue et al. (2020) conducted a meta-analysis in non-cardiac surgery (n=1,711,766). Perioperative beta-blocker exposure vs. No beta-blocker exposure was evaluated on 30-day all-cause mortality (ACM) (RR 0.83, 95% CI 0.72 to 0.96). Perioperative beta-blocker exposure was associated with reduced 30-day all-cause mortality (RR 0.83; 95% CI 0.72-0.96) following non-cardiac surgery, but not with 30-day MACE or stroke risk.
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