The risks and benefits of perioperative beta-blockade have been debated for decades. While the benefits are widely accepted in patients undergoing cardiac surgery, the value of perioperative beta-blockade in non-cardiac surgery (NCS) is not clear. A new large retrospective observational analysis from the VA helps define which patients are candidates for beta-blockers. Patients undergoing NCS from 2008 to 2013 were evaluated (n = 314,114).

Patients were assigned a cardiovascular risk score of 0-4, with one point each for renal failure, coronary artery disease, diabetes, and surgery in a major body cavity. The endpoint was 30-day surgical mortality. Beta-blocker use was defined as a dose 8 hours pre-op to 24 hours post-op. Beta-blockade significantly lowered mortality by 37% in patients with 3-4 cardiac risk factors undergoing NCS (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.43-0.93) but had no effect on patients with 1-2 risk factors. Beta-blockade increased the risk of death in patients with no risk factors undergoing NCS (OR, 1.19, 95% CI, 1.06-1.35).

The authors conclude that perioperative beta-blockade appears to be beneficial for patients with high cardiac risk factors undergoing NCS, but it increased the risk of death in those with no cardiac risk factors (JAMA Surg, Published online May 27, 2015. doi:10.1001/jamasurg.2015.86).