BMJ, doi: 10.1136/bmj.38603.746944.3A, (Published 6 October 2005)

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

Donald Redelmeier ^1*, Damon Scales ², Alexander Kopp ³

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

^* Correspondence to: DAR{at}ICES.ON.CA.

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.

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(Accepted 23 August 2005)
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