Abstract
The aim of this study is to determine if COPD patients undergoing lung resection with perioperative β-blocker use are more likely to suffer postoperative COPD exacerbations than those that did not receive perioperative β-blockers. Methods. A historical cohort study of COPD patients, undergoing lung resection surgery at Memorial Sloan-Kettering Cancer Center between 2002 and 2006. Primary outcomes were the rate of postoperative COPD exacerbations, defined as any initiation or increase of glucocorticoids for documented bronchospasm. Results. 520 patients with COPD were identified who underwent lung resection. Of these, 205 (39%) received perioperative β-blockers and 315 (61%) did not. COPD was mild among 361 patients (69% of all patients), moderate in 117 patients (23%), and severe in 42 patients (8%). COPD exacerbations occurred among 11 (5.4%) patients who received perioperative β-blockers and among 20 (6.3%) patients who did not. Secondary outcomes, which included respiratory failure, 30-day mortality, and the presence or absence of any cardiovascular complication, ICU transfer, cardiovascular complication, or readmission within 30 days, did not differ in prevalence between the two groups. Conclusions. This study implies that perioperative β-blockers use among COPD patients undergoing lung resection surgery does not impact the rate of exacerbations.
Highlights
An estimated 71% of patients with non-small-cell lung cancer undergo potentially curative lung cancer resection in the United States every year [1]
The Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress EKG (DECREASE) trial, reporting a 90% relative risk reduction in the combined endpoint of postoperative cardiac death and nonfatal myocardial infarction, included fabricated data and should, be discredited [19,20,21,22]. This was further challenged by the Perioperative Ischemic Evaluation (POISE) trial, a far superior randomized control trial, which showed an increased mortality and stroke with high dose perioperative β-blockade [23]
A more recent scientific review of the data by the American College of Cardiology and the American Heart Association in 2014 revised the clinical practice perioperative guidelines and should be taken into consideration when contemplating the use of perioperative beta-blockers
Summary
An estimated 71% of patients with non-small-cell lung cancer undergo potentially curative lung cancer resection in the United States every year [1]. The risk of cardiac complications can be decreased among some patients at high risk for acute coronary syndrome by the use of perioperative β-blockers. For instance, found that the use of atenolol, a β1 selective agent, was associated with improved mortality among 200 V.A. patients with greater than two risk factors for coronary artery disease [8]. Concern of precipitating bronchospasm in this fashion has led many investigators to exclude patients with chronic obstructive pulmonary disease (COPD) from clinical trials involving β-blockers. Such concerns may not be entirely justified [9]. Camsari et al found that metoprolol given for coronary artery disease did not decrease the forced expiratory volume in one second (FEV1) among 50 patients with stable moderate to severe COPD [12]
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