Association of Perioperative β-Blockade With Mortality and Cardiovascular Morbidity Following Major Noncardiac Surgery
Association of Perioperative β-Blockade With Mortality and Cardiovascular Morbidity Following Major Noncardiac Surgery
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DOI：
10.1001/jama.2013.4135
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发表时间：
2013-04-24
影响因子：
120.7
通讯作者：
Henderson, William G.
中科院分区：
文献类型：
--
作者：
London, Martin J.;Hur, Kwan;Henderson, William G.
重要性 围手术期 β 受体阻滞剂对接受非心脏手术的患者的有效性仍存在争议。目的 确定接受非心脏手术的患者围手术期早期接触 β 受体阻滞剂与术后 30 天结果的关联。设计、环境和患者 2005 年 1 月至 2010 年 8 月期间，在 104 个 VA 医疗中心接受治疗的 136 745 名患者进行了 1:1 匹配的倾向评分（37 805 配对）。主要结果和措施 所有原因导致 30 天死亡率和心脏发病率（心脏骤停或 Q 波心肌梗死）。结果 总共 55 138 名患者 (40.3%)暴露于β受体阻滞剂。 13 863 名接受血管手术的患者中，66.7% 的暴露量（95% CI，65.9%-67.5%）高于 122 882 名接受非血管手术的患者中的 37.4%（95% CI，37.1%-37.6%；P
Importance The effectiveness of perioperative beta-blockade in patients undergoing noncardiac surgery remains controversial.Objective To determine the associations of early perioperative exposure to beta-blockers with 30-day postoperative outcome in patients undergoing noncardiac surgery.Design, Setting, and Patients A retrospective cohort analysis evaluating exposure to beta-blockers on the day of or following major noncardiac surgery among a population-based sample of 136 745 patients who were 1: 1 matched on propensity scores (37 805 matched pairs) treated at 104 VA medical centers from January 2005 through August 2010.Main Outcomes and Measures All cause 30-day mortality and cardiac morbidity (cardiac arrest or Q-wave myocardial infarction).Results Overall 55 138 patients (40.3%) were exposed to beta-blockers. Exposure was higher in the 66.7% of 13 863 patients undergoing vascular surgery (95% CI, 65.9%-67.5%) than in the 37.4% of 122 882 patients undergoing nonvascular surgery (95% CI, 37.1%-37.6%; P