Impact Of Preoperative Beta-blockade On Outcomes Following The Surgical Treatment Of Atherosclerotic Disease

Abstract

INTRODUCTION AND OBJECTIVES Beta-blockers are integral to the treatment of many cardiovascular diseases however studies of their potential perioperative benefit remain mixed in their findings. The objective of this study was to determine the impact of preoperative beta-blockade in patients undergoing vascular surgery to treat atherosclerotic disease (carotid endarterectomies and supra- and infra-inguinal bypasses). METHODS The National Surgical Quality Improvement Program (NSQIP) targeted datasets were queried for patients undergoing carotid endarterectomies and supra- and infra-inguinal bypasses between 2011-2019. Rates of major adverse cardiovascular events (MACE) including myocardial infarction (MI), stroke and death were compared between patients with and without preoperative beta-blockade (BB). Multivariable logistic regression models were created to adjust for differences in baseline characteristics between groups. RESULTS Of the 84,331 patients included, 56% received BB. Beta-blocker use has decreased from 59.7% in 2011 to 53.9% in 2019 (p<.001). Patients receiving BB were more likely to have diabetes (45% vs 32%, p<0.001), heart failure (4% vs 1%, p<0.001), or be on an anti-hypertensive medication (93% vs 69%, p<0.001). Unadjusted rates of death (1.5% vs 0.96%, p<0.001) and MACE (4.2% vs 2.7%, p<0.001) were higher in the BB group. After adjusting for differences in baseline characteristics, BB was associated with an increased risk of MACE (OR=1.24, 95%CI=1.14-1.34). On subgroup analysis, BB was associated with increased risk of MACE following carotid endarterectomy (OR=1.31, 95%CI=1.15-1.49), infra-inguinal bypass (OR 1.191, 95%CI=1.05-1.34), and supra-inguinal bypass (OR 1.252, 95%CI=1.035-1.514). BB was associated with increased risk of MACE following open procedures (OR=1.29, 95%CI=1.17-1.41), but not endovascular procedures. CONCLUSIONS Preoperative beta-blockade is associated with an increased risk of MACE following common vascular surgery procedures, even after controlling for baseline health status, which affects over half of patients undergoing surgical treatment of atherosclerotic disease. Risk of MACE in patients receiving beta-blocker therapy may be lessened by endovascular approach. Beta-blockers are integral to the treatment of many cardiovascular diseases however studies of their potential perioperative benefit remain mixed in their findings. The objective of this study was to determine the impact of preoperative beta-blockade in patients undergoing vascular surgery to treat atherosclerotic disease (carotid endarterectomies and supra- and infra-inguinal bypasses). The National Surgical Quality Improvement Program (NSQIP) targeted datasets were queried for patients undergoing carotid endarterectomies and supra- and infra-inguinal bypasses between 2011-2019. Rates of major adverse cardiovascular events (MACE) including myocardial infarction (MI), stroke and death were compared between patients with and without preoperative beta-blockade (BB). Multivariable logistic regression models were created to adjust for differences in baseline characteristics between groups. Of the 84,331 patients included, 56% received BB. Beta-blocker use has decreased from 59.7% in 2011 to 53.9% in 2019 (p<.001). Patients receiving BB were more likely to have diabetes (45% vs 32%, p<0.001), heart failure (4% vs 1%, p<0.001), or be on an anti-hypertensive medication (93% vs 69%, p<0.001). Unadjusted rates of death (1.5% vs 0.96%, p<0.001) and MACE (4.2% vs 2.7%, p<0.001) were higher in the BB group. After adjusting for differences in baseline characteristics, BB was associated with an increased risk of MACE (OR=1.24, 95%CI=1.14-1.34). On subgroup analysis, BB was associated with increased risk of MACE following carotid endarterectomy (OR=1.31, 95%CI=1.15-1.49), infra-inguinal bypass (OR 1.191, 95%CI=1.05-1.34), and supra-inguinal bypass (OR 1.252, 95%CI=1.035-1.514). BB was associated with increased risk of MACE following open procedures (OR=1.29, 95%CI=1.17-1.41), but not endovascular procedures. Preoperative beta-blockade is associated with an increased risk of MACE following common vascular surgery procedures, even after controlling for baseline health status, which affects over half of patients undergoing surgical treatment of atherosclerotic disease. Risk of MACE in patients receiving beta-blocker therapy may be lessened by endovascular approach.