BMJ  2005;331:932 (22 October), doi:10.1136/bmj.38603.746944.3A (published 6 October 2005)

Paper

blockers for elective surgery in elderly patients: population based, retrospective cohort study

¹ Sunnybrook and Women's College Health Sciences Centre, G-151, 2075 Bayview Ave, Ontario, Canada M4N 3M5, ² Department of Medicine, University of Toronto, Clinical Epidemiology and Health Care Research Program, Sunnybrook and Women's College Health Sciences Centre, ³ Institute for Clinical Evaluative Sciences, Sunnybrook and Women's College Health Sciences Centre

Objective To test whether atenolol (a long acting blocker) and metoprolol (a short acting blocker) are associated with equivalent reductions in risk for elderly patients undergoing elective surgery.

Design Population based, retrospective cohort analysis.

Setting Acute care hospitals in Ontario, Canada, over one decade.

Participants Consecutive patients older than 65 who were admitted for elective surgery, without symptomatic coronary disease.

Main outcome measure Death or myocardial infarction.

Results 37 151 patients were receiving atenolol or metoprolol before surgery, of which the most common operations were orthopaedic or abdominal procedures. As expected, the two groups were similar in demographic characteristics, medical therapy, and type of surgery. 1038 patients experienced a myocardial infarction or died, a rate that was significantly lower for patients receiving atenolol than for those receiving metoprolol (2.5% v 3.2%, P < 0.001). The decreased risk with atenolol persisted after adjustment for measured demographic, medical, and surgical factors; extended to comparisons of other long acting and short acting blockers; was accentuated in analyses that focused on patients with the clearest evidence of blocker treatment; and reflected the immediate postoperative interval.

Conclusions Patients receiving metoprolol do not have as low a perioperative cardiac risk as patients receiving atenolol, in accord with possible acute withdrawal after missed doses.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Related Articles

Effect of perioperative blockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled, blinded multicentre trial

Anne Benedicte Juul, Jørn Wetterslev, Christian Gluud, Allan Kofoed-Enevoldsen, Gorm Jensen, Torben Callesen, Peter Nørgaard, Kim Fruergaard, Morten Bestle, Rune Vedelsdal, André Miran, Jon Jacobsen, Jakob Roed, Maj-Britt Mortensen, Lise Jørgensen, Jørgen Jørgensen, Marie-Louise Rovsing, Pernille Lykke Petersen, Frank Pott, Merete Haas, Rikke Albret, Lise Lotte Nielsen, Gun Johansson, Pia Stjernholm, Yvonne Mølgaard, Nikolai Bang Foss, Jeanie Elkjær, Bjørn Dehlie, Klavs Boysen, Dusanka Zaric, Anne Munksgaard, Jørn Bo Madsen, Bjarne Øberg, Boris Khanykin, Tine Blemmer, Stig Yndgaard, Grazyna Perko, Lars Peter Wang, Per Winkel, Jørgen Hilden, Per Jensen, Nader Salas DIPOM Trial Group
BMJ 2006 332: 1482. [Abstract] [Full Text] [PDF]

Choose long acting blockers for elderly surgical patients
BMJ 2005 331: 0. [Full Text]

Better decisions

Trish Groves
BMJ 2005 331: 0. [Extract] [Full Text] [PDF]

blockers for patients at risk of cardiac events during non-cardiac surgery

Stephen Bolsin and Mark Colson
BMJ 2005 331: 919-920. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Gregoratos, G. (2008). Current Guideline-Based Preoperative Evaluation Provides the Best Management of Patients Undergoing Noncardiac Surgery. Circulation 117: 3134-3144 [Full text]  
• Poldermans, D., Hoeks, S. E., Feringa, H. H. (2008). Pre-Operative Risk Assessment and Risk Reduction Before Surgery. J Am Coll Cardiol 51: 1913-1924 [Abstract] [Full text]  
• Bushnell, B. D., Horton, J. K., McDonald, M. F., Robertson, P. G. (2008). Perioperative Medical Comorbidities in the Orthopaedic Patient. J Am Acad Orthop Surg 16: 216-227 [Abstract] [Full text]  
• Beattie, W. S., Wijeysundera, D. N., Karkouti, K., McCluskey, S., Tait, G. (2008). Does Tight Heart Rate Control Improve Beta-Blocker Efficacy? An Updated Analysis of the Noncardiac Surgical Randomized Trials. Anesth. Analg. 106: 1039-1048 [Abstract] [Full text]  
• Developed in Collaboration With the American Socie, , WRITING COMMITTEE MEMBERS, , Fleisher, L. A., Beckman, J. A., Brown, K. A., Calkins, H., Chaikof, E., Fleischmann, K. E., Freeman, W. K., Froehlich, J. B., Kasper, E. K., Kersten, J. R., Riegel, B., Robb, J. F., ACC/AHA TASK FORCE MEMBERS, , Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Anderson, J. L., Antman, E. M., Buller, C. E., Creager, M. A., Ettinger, S. M., Faxon, D. P., Fuster, V., Halperin, J. L., Hiratzka, L. F., Hunt, S. A., Lytle, B. W., Nishimura, R., Ornato, J. P., Page, R. L., Riegel, B., Tarkington, L. G., Yancy, C. W. (2008). ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Anesth. Analg. 106: 685-712 [Full text]  
• Fleisher, L. A., Beckman, J. A., Brown, K. A., Calkins, H., Chaikof, E., Fleischmann, K. E., Freeman, W. K., Froehlich, J. B., Kasper, E. K., Kersten, J. R., Riegel, B., Robb, J. F. (2007). ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation 116: e418-e499 [Full text]  
• Fleisher, L. A., Beckman, J. A., Brown, K. A., Calkins, H., Chaikof, E., Fleischmann, K. E., Freeman, W. K., Froehlich, J. B., Kasper, E. K., Kersten, J. R., Riegel, B., Robb, J. F. (2007). ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation 116: 1971-1996 [Full text]  
• Schouten, O., Fleisher, L. A., London, M. J., Feringa, H. H. H., Bax, J. J., Poldermans, D. (2007). Perioperative {beta}-Blockade: Still Not Enough for Adequate Cardioprotection!. Anesth. Analg. 105: 279-280 [Full text]  
• Schouten, O., Bax, J. J., Dunkelgrun, M., Feringa, H. H.H., Poldermans, D. (2007). Pro: Beta-Blockers Are Indicated for Patients at Risk for Cardiac Complications Undergoing Noncardiac Surgery. Anesth. Analg. 104: 8-10 [Full text]  
• Fleisher, L. A., Beckman, J. A., Brown, K. A., Calkins, H., Chaikof, E. L., Fleischmann, K. E., Freeman, W. K., Froehlich, J. B., Kasper, E. K., Kersten, J. R., Riegel, B., Robb, J. F. (2007). ACC/AHA 2006 Guideline Update on Perioperative Cardiovascular Evaluation for Noncardiac Surgery: Focused Update on Perioperative Beta-Blocker Therapy -- A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Anesth. Analg. 104: 15-26 [Abstract] [Full text]  
• Juul, A. B., Wetterslev, J., Gluud, C., Kofoed-Enevoldsen, A., Jensen, G., Callesen, T., Norgaard, P., Fruergaard, K., Bestle, M., Vedelsdal, R., Miran, A., Jacobsen, J., Roed, J., Mortensen, M.-B., Jorgensen, L., Jorgensen, J., Rovsing, M.-L., Petersen, P. L., Pott, F., Haas, M., Albret, R., Nielsen, L. L., Johansson, G., Stjernholm, P., Molgaard, Y., Foss, N. B., Elkjaer, J., Dehlie, B., Boysen, K., Zaric, D., Munksgaard, A., Madsen, J. B., Oberg, B., Khanykin, B., Blemmer, T., Yndgaard, S., Perko, G., Wang, L. P., Winkel, P., Hilden, J., Jensen, P., Salas, N., DIPOM Trial Group, (2006). Effect of perioperative beta blockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled, blinded multicentre trial.. BMJ 332: 1482-1482 [Abstract] [Full text]  
• Fleisher, L. A., Beckman, J. A., Brown, K. A., Calkins, H., Chaikof, E., Fleischmann, K. E., Freeman, W. K., Froehlich, J. B., Kasper, E. K., Kersten, J. R., Riegel, B., Robb, J. F., Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Anderson, J. L., Antman, E. M., Faxon, D. P., Fuster, V., Halperin, J. L., Hiratzka, L. F., Hunt, S. A., Lytle, B. W., Nishimura, R., Page, R. L., Riegel, B. (2006). ACC/AHA 2006 Guideline Update on Perioperative Cardiovascular Evaluation for Noncardiac Surgery: Focused Update on Perioperative Beta-Blocker Therapy: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society for Vascular Medicine and Biology. J Am Coll Cardiol 47: 2343-2355 [Full text]  
• McDonald, C. G., Majumdar, S. R., Mahon, J. L., Johnson, J. A. (2006). The Effectiveness of {beta}-Blockers After Myocardial Infarction in Patients With Type 2 Diabetes: Response to Bell. Diabetes Care 29: 483-484 [Full text]  
• (2005). For Surgical Protection, Are All {beta}-Blockers the Same?. JWatch General 2005: 4-4 [Full text]  
• Bolsin, S., Colson, M. (2005). {beta} blockers for patients at risk of cardiac events during non-cardiac surgery. BMJ 331: 919-920 [Full text]  

Rapid Responses:

Read all Rapid Responses

Where are the large clinical trials in anaesthesia

Richard J Innes
bmj.com, 28 Oct 2005 [Full text]

No Nitrates does not mean absence of coronary disease

Atef Michael
bmj.com, 28 Oct 2005 [Full text]

Beta Blockers for elective Surgery in the Elderly

Samer-ul Haque
bmj.com, 16 Nov 2005 [Full text]

A response to ‘Beta-blockers for elective surgery in elderly patients: population based, retrospective cohort study’.

Bruce M Biccard, et al.
bmj.com, 22 Nov 2005 [Full text]