Perioperative Medicine  |   December 2018
Early Resumption of β Blockers Is Associated with Decreased Atrial Fibrillation after Noncardiothoracic and Nonvascular Surgery: A Cohort Analysis
Author Notes
  • From the Surgical Intensive Care Unit, Center for Critical Care (A.K.K., D.F.N.), Department of Outcomes Research (A.K.K., A.J.N., E.J.M., J.Y., E.M.R., Q.M.R., D.I.S.), Department of Quantitative Health Sciences (E.J.M., J.Y.), and Department of General Anesthesia (A.K.), Cleveland Clinic, Cleveland, Ohio; University of Michigan Health System, Ann Arbor, Michigan (M.D.).
  • This article is featured in “This Month in Anesthesiology,” page 1A.
    This article is featured in “This Month in Anesthesiology,” page 1A.×
  • Part of the work presented in this article has been presented as a best-of-meeting abstract for clinical sciences at the American Society of Anesthesiologists (ASA) meeting in Boston, Massachusetts, October 21–25, 2017.
    Part of the work presented in this article has been presented as a best-of-meeting abstract for clinical sciences at the American Society of Anesthesiologists (ASA) meeting in Boston, Massachusetts, October 21–25, 2017.×
  • Submitted for publication November 14, 2017. Accepted for publication August 30, 2018.
    Submitted for publication November 14, 2017. Accepted for publication August 30, 2018.×
  • Address correspondence to Dr. Khanna: Center for Critical Care, Anesthesiology Institute, Cleveland, Clinic, 9500 Euclid Avenue, G-58, Cleveland, Ohio 44195. ashish@or.org. 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
Perioperative Medicine   |   December 2018
Early Resumption of β Blockers Is Associated with Decreased Atrial Fibrillation after Noncardiothoracic and Nonvascular Surgery: A Cohort Analysis
Anesthesiology 12 2018, Vol.129, 1101-1110. doi:10.1097/ALN.0000000000002457
Anesthesiology 12 2018, Vol.129, 1101-1110. doi:10.1097/ALN.0000000000002457
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Use of beta (β) blockers in the perioperative period is associated with reduced incidence of postoperative atrial fibrillation

  • In chronic β-blocker users, optimal timing for β-blocker resumption in the postoperative setting is unclear

What This Article Tells Us That Is New:

  • Resumption of postoperative β-blocker therapy by the end of postoperative day 1 is associated with reduced incidence of postoperative atrial fibrillation in general surgical patients (noncardiac, nonthoracic, nonvascular surgeries) when compared with patients who resumed β-blocker therapy after postoperative day 1

  • There was not a significant difference in incidence of postoperative atrial fibrillation for those patients who postoperatively resumed β-blocker therapy on the day of surgery versus anytime thereafter

Background: Beta (β) blockers reduce the risk of postoperative atrial fibrillation and should be restarted after surgery, but it remains unclear when best to resume β blockers postoperatively. The authors thus evaluated the relationship between timing of resumption of β blockers and atrial fibrillation in patients recovering from noncardiothoracic and nonvascular surgery.

Methods: The authors evaluated 8,201 adult β-blocker users with no previous history of atrial fibrillation who stayed at least two nights after noncardiothoracic and nonvascular surgery as a retrospective observational cohort. After propensity score matching on baseline and intraoperative variables, 1,924 patients who did resume β blockers by the end of postoperative day 1 were compared with 973 patients who had not resumed by that time on postoperative atrial fibrillation using logistic regression. A secondary matched analysis compared 3,198 patients who resumed β blockers on the day of surgery with 3,198 who resumed thereafter.

Results: Of propensity score–matched patients who resumed β blockers by end of postoperative day 1, 4.9% (94 of 1,924) developed atrial fibrillation, compared with 7.0% (68 of 973) of those who resumed thereafter (adjusted odds ratio, 0.69; 95% CI, 0.50–0.95; P = 0.026). Patients who resumed β blockers on day of surgery had an atrial fibrillation incidence of 4.9% versus 5.8% for those who started thereafter (odds ratio, 0.84; 95% CI, 0.67–1.04; P = 0.104).

Conclusions: Resuming β blockers in chronic users by the end of the first postoperative day may be associated with lower odds of in-hospital atrial fibrillation. However, there seems to be little advantage to restarting on the day of surgery itself.