Perioperative Continuation of Chronic Beta-Blockers in Non-Cardiac Surgery

Background: Perioperative β-blocker management in patients undergoing non-cardiac surgery remains controversial. While guidelines recommend continuation of chronic β-blocker therapy, direct randomized evidence supporting this practice is limited, and concerns persist regarding potential adverse effects. Objectives: To evaluate the impact of perioperative continuation versus discontinuation of chronic β-blocker therapy on postoperative outcomes in patients undergoing elective non-cardiac surgery. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted. Studies including adult patients on chronic β-blocker therapy undergoing elective non-cardiac surgery were identified. The primary outcome was 30-day all-cause mortality. The secondary outcome was nonfatal myocardial infarction. Pooled effect estimates were calculated using a random-effects inverse-variance model and reported as odds ratios (ORs) or risk ratios (RRs) with 95% confidence intervals (CIs). Results: Six randomized controlled trials including 16,280 patients were analyzed for 30-day all-cause mortality. β-blocker continuation was associated with a significant reduction in mortality compared with discontinuation (OR 0.22, 95% CI 0.06-0.82; P = 0.02), although substantial heterogeneity was observed (I 2 = 96%). This variability was largely driven by discordant findings from the POISE trial.Three randomized controlled trials including 11,853 patients were analyzed for nonfatal myocardial infarction. β-blocker therapy was associated with a significant reduction in myocardial infarction (RR 0.60, 95% CI 0.43-0.84; P = 0.003), with moderate heterogeneity (I 2 = 52%) and consistent directionality across studies. Conclusions: Continuation of chronic β-blocker therapy in the perioperative period is associated with reduced nonfatal myocardial infarction and may also reduce 30-day mortality, although the latter finding is limited by substantial heterogeneity. These results support guideline recommendations while emphasizing the need for individualized perioperative management and further research to define optimal patient selection and treatment strategies.