Role of perioperative beta-blockers in mortality risk
2006 retrospective study of 663,665 adults undergoing major noncardiac surgery. 18% received beta-blockers (14% RCRI-0, 44% RCRI-4+).
RCRI 0: 1.4% mortality, OR 1.36 [1.27-1.45]
RCRI 1: 2.2% mortality, OR 1.09 [1.01-1.19]
RCRI 2: 3.9% mortality, OR 0.88 [0.80-0.98]
RCRI 3: 5.8% mortality, OR 0.71 [0.63-0.80]
RCRI 4+: 7.4% mortality, OR 0.58 [0.50-0.67]
Choice of beta-blocker agent for perioperative administration
Cardiovascular benefit of perioperative beta-blockers has only been demonstrated for beta-adrenergic receptor 1-selective antagonists, such as atenolol or metoprolol.
Retrospective cohort analysis (Redelmeier BMJ 2005) of treatment with atenolol vs. metoprolol in elderly indicated a decreased rate of death or MI after treatment with atenolol relative to metoprolol (2.5% vs 3.2% mortality).
Although nonselective agents such as propanolol are not initiated for perioperative therapy due to adverse pulmonary and peripheral arterial effects, patients on long-term propanolol use do not need to switch agent perioperatively.