How strong is the evidence for the use of perioperative β blockers in non-cardiac surgery? Systematic review and meta-analysis of randomised controlled trials

P. J. Devereaux, W. Scott Beattie, Peter T.L. Choi, Neal H. Badner, Gordon H. Guyatt, Juan C. Villar, Claudio S. Cinà, Kate Leslie, Michael J. Jacka, Victor M. Montori, Mohit Bhandari, Alvaro Avezum, Alexandre B. Cavalcanti, Julian W. Giles, Thomas Schricker, Homer Yang, Carl Johan Jakobsen, Salim Yusuf

Research output: Contribution to journalReview article

356 Scopus citations

Abstract

Objective: To determine the effect of perioperative β blocker treatment in patients having non-cardiac surgery. Design: Systematic review and meta-analysis. Data sources: Seven search strategies, including searching two bibliographic databases and hand searching seven medical journals. Study selection and outcomes: We included randomised controlled trials that evaluated β blocker treatment in patients having non-cardiac surgery. Perioperative outcomes within 30 days of surgery included total mortality, cardiovascular mortality, non-fatal myocardial infarction, non-fatal cardiac arrest, non-fatal stroke, congestive heart failure, hypotension needing treatment, bradycardia needing treatment, and bronchospasm. Results: Twenty two trials that randomised a total of 2437 patients met the eligibility criteria. Perioperative β blockers did not show any statistically significant beneficial effects on any of the individual outcomes and the only nominally statistically significant beneficial relative risk was 0.44 (95% confidence interval 0.20 to 0.97, 99% confidence interval 0.16 to 1.24) for the composite outcome of cardiovascular mortality, non-fatal myocardial infarction, and non-fatal cardiac arrest. Methods adapted from formal interim monitoring boundaries applied to cumulative meta-analysis showed that the evidence failed, by a considerable degree, to meet standards for forgoing additional studies. The individual safety outcomes in patients treated with perioperative β blockers showed a relative risk for bradycardia needing treatment of 2.27 (95% CI 1.53 to 3.36, 99% CI 1.36 to 3.80) and a nominally statistically significant relative risk for hypotension needing treatment of 1.27 (95% CI 1.04 to 1.56, 99% CI 0.97 to 1.66). Conclusion: The evidence that perioperative β blockers reduce major cardiovascular events is encouraging but too unreliable to allow definitive conclusions to be drawn.

Original languageEnglish (US)
Pages (from-to)313-316
Number of pages4
JournalBritish medical journal
Volume331
Issue number7512
DOIs
StatePublished - Aug 6 2005

ASJC Scopus subject areas

  • Medicine(all)

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