Beta blockers protective in non-vascular noncardiac surgery, but not in vascular surgery???

Dr London and colleagues from San Francisco VA have just published a study in JAMA (retrospective; propensity analysis) showing that beta blockers are NOT protective in vascular surgery.  However, they are in non-vascular noncardiac surgery.  The protection increases as the RCRI increases.

Hypotheses as to why no protection in vascular surgery patients:

  • More careful periop care in vascular surgery patients?
  • I think it’s because vascular surgery patients bleed more than others.  In Kamel et al (see below), vascular cases were only 12.5% of cases analysed, but 41% of hemorrhage cases, where definition of major hemorrhage was “requiring transfusion of >4 U of packed red blood cells (PRBCs) or whole blood based on the NSQIP definition”). “Bleeding is Rarely Good for You!” below is the accompanying editorial.

I asked Dr. London if they had analysed bleeding and transfusion in this cohort.  They’d like to do so, but await funding to be able to examine.

Circulation. 2012 Jul 10;126(2):169-71. doi: 10.1161/CIRCULATIONAHA.112.115196.

Circulation. 2012 Jul 10;126(2):169-71. doi: 10.1161/CIRCULATIONAHA.112.115196.

Circulation. 2012 Jul 10;126(2):207-12. doi: 10.1161/CIRCULATIONAHA.112.094326. Epub 2012 Jun 7. Association between major perioperative hemorrhage and stroke or Q-wave myocardial infarction. Kamel H, Johnston SC, Kirkham JC, Turner CG, Kizer JR, Devereux RB, Iadecola C. Source Department of Neurology and Neuroscience, Weill Cornell Medical College, New York, NY 10065, USA. hok9010@med.cornell.edu

Circulation. 2012 Jul 10;126(2):207-12. doi: 10.1161/CIRCULATIONAHA.112.094326. Epub 2012 Jun 7.
Association between major perioperative hemorrhage and stroke or Q-wave myocardial infarction.
Kamel H, Johnston SC, Kirkham JC, Turner CG, Kizer JR, Devereux RB, Iadecola C.
Source
Department of Neurology and Neuroscience, Weill Cornell Medical College, New York, NY 10065, USA. hok9010@med.cornell.edu

Association of Perioperative β-Blockade With Mortality and Cardiovascular Morbidity Following Major Noncardiac Surgery Martin J. London, MD; Kwan Hur, PhD; Gregory G. Schwartz, MD, PhD; William G. Henderson, PhD, MPH JAMA. 2013;309(16):1704-1713. doi:10.1001/jama.2013.4135.

Association of Perioperative β-Blockade With Mortality and Cardiovascular Morbidity Following Major Noncardiac Surgery
Martin J. London, MD; Kwan Hur, PhD; Gregory G. Schwartz, MD, PhD; William G. Henderson, PhD, MPH
JAMA. 2013;309(16):1704-1713. doi:10.1001/jama.2013.4135.

 

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