Perioperative Medicine  |   January 2016
Effects of Preoperative β-Blocker Use on Clinical Outcomes after Coronary Artery Bypass Grafting: A Report from the Japanese Cardiovascular Surgery Database
Author Notes
  • From the Japan Cardiovascular Surgery Database Organization, Tokyo, Japan (S.K., H.M., N.M., K.I., S.K., S.T.); and Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S.K., K.F.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication December 29, 2014. Accepted for publication August 4, 2015.
    Submitted for publication December 29, 2014. Accepted for publication August 4, 2015.×
  • Address correspondence to Dr. Kohsaka: Department of Cardiology, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, Japan. kohsaka@cpnet.med.keio.ac.jp. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Cardiovascular Anesthesia / Quality Improvement
Perioperative Medicine   |   January 2016
Effects of Preoperative β-Blocker Use on Clinical Outcomes after Coronary Artery Bypass Grafting: A Report from the Japanese Cardiovascular Surgery Database
Anesthesiology 1 2016, Vol.124, 45-55. doi:10.1097/ALN.0000000000000901
Anesthesiology 1 2016, Vol.124, 45-55. doi:10.1097/ALN.0000000000000901
Abstract

Background: The authors evaluated the effect of preoperative β-blocker use on early outcomes in patients undergoing coronary artery bypass grafting (CABG) in Japan.

Methods: The authors analyzed 34,980 cases of isolated CABGs, performed between 2008 and 2011, at the 333 sites recorded in the Japanese Cardiovascular Surgical Database. In addition to the use of multivariate models, a one-to-one matched analysis, based on estimated propensity scores for patients with or without preoperative β-blocker use, was performed.

Results: The study population (mean age, 68 yr) comprised 20% women, and β-blockers were used in 10,496 patients (30%), who were more likely to have risk factors and comorbidities than patients in whom β-blockers were not used. In the β-blocker and non-β-blocker groups, the crude in-hospital mortality rate was 1.7 versus 2.5%, whereas the composite complication rate was 9.7 versus 11.6%, respectively. However, after adjustment, preoperative β-blocker use was not a predictor of in-hospital mortality (odds ratio, 1.00; 95% CI, 0.82 to 1.21) or complications (odds ratio, 0.99; 95% CI, 0.91 to 1.08). When the outcomes of the two propensity-matched patient groups were compared, differences were not seen in the 30-day operative mortality (1.6 vs. 1.5%, respectively; P = 0.49) or postoperative complication (9.8 vs. 9.7%; P = 1.00) rates. The main findings were broadly consistent in a subgroup analysis of low-risk and high-risk groups.

Conclusion: In this nationwide registry, the use of preoperative β-blockers did not affect short-term mortality or morbidity in patients undergoing CABG.

Abstract

Using a Japanese national cardiovascular surgical registry, the authors compared patients undergoing bypass grafting who were taking β-blockers preoperatively with those were not. Unadjusted results favored chronic β-blocker use. But after adjustment (the presumably more reliable results), β-blocker use did not alter complications, in-hospital mortality, or 30-day mortality

Supplemental Digital Content is available in the text.