The Johns Hopkins Surgery Center for Outcomes Research (JSCOR), Johns Hopkins School of Medicine, Baltimore, MD.
Division of Vascular and Endovascular Surgery, Department of Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD.
Ann Surg. 2018 Jun;267(6):1185-1190. doi: 10.1097/SLA.0000000000002291.
To assess the effect of perioperative beta blocker (BB) use on postoperative in-hospital mortality after open repair of abdominal aortic aneurysm (OAR).
Postoperative mortality after OAR ranges from 3.0% to 4.5%. Insight about the effect of BBs on postoperative mortality after OAR is currently lacking.
This is a retrospective study of patients undergoing OAR from 2009-Q3 to 2015-Q1 in the Premier Healthcare Database. The Premier Healthcare Database includes data representing 20% of all inpatient US discharges annually. Patients under 45 years, admitted after a trauma or who underwent multiple aortic repair procedures, were excluded. Multivariable logistic regression models were created to assess the relationship between perioperative BB use and postoperative in-hospital mortality.
Of 6515 patients admitted for OAR, 5423 (83.2%) received perioperative BBs. Patients who received BBs were more likely to develop major adverse events compared with those who did not (45.6% vs 35.2%; P < 0.001); however, failure to rescue was lower among BB users (7.6% vs 19.5%; P < 0.001). In a multivariable logistic regression model, BB use was associated with 57% [odds ratio 0.43, 95% confidence interval (CI) 0.31-0.56, P = 0.001) and 81% (odds ratio 0.19, 95% CI 0.11-0.31, P < 0.001) lower odds of mortality among patients without and with a history of coronary artery disease, respectively. The predicted mortality (95% CI) for patients who did not receive BBs, or received low, intermediate, or high-intensity BBs was 11.6% (8.0%-15.2%), 5.4% (4.4%-6.5%), 2.5% (1.9%-3.0%), and 3.3% (2.3%-4.3%), respectively.
In-hospital use of BBs was associated with a significant reduction in postoperative mortality after OAR. This is the first study to demonstrate a dose-response relationship between BBs and postoperative mortality after OAR.
评估腹部主动脉瘤（OAR）开放修复术后围手术期使用β受体阻滞剂（BB）对住院内术后死亡率的影响。
OAR 术后死亡率范围为 3.0%至 4.5%。目前缺乏关于 BB 对 OAR 术后死亡率影响的相关信息。
这是一项在 Premier Healthcare Database 中回顾性研究 2009 年第三季度至 2015 年第一季度接受 OAR 的患者。Premier Healthcare Database 包含了每年 20%的美国住院患者的数据。排除 45 岁以下、因创伤入院或接受多次主动脉修复手术的患者。创建多变量逻辑回归模型来评估围手术期 BB 使用与术后住院内死亡率之间的关系。
在 6515 例接受 OAR 治疗的患者中，5423 例（83.2%）接受了围手术期 BB。与未使用 BB 的患者相比，使用 BB 的患者更有可能发生重大不良事件（45.6% vs 35.2%；P < 0.001）；但 BB 使用者的抢救失败率较低（7.6% vs 19.5%；P < 0.001）。在多变量逻辑回归模型中，BB 使用与无冠心病史和有冠心病史的患者的死亡率降低 57%[比值比 0.43，95%置信区间（CI）0.31-0.56，P = 0.001]和 81%（比值比 0.19，95% CI 0.11-0.31，P < 0.001）相关。未接受 BB 治疗、接受低、中、高强度 BB 治疗的患者的预测死亡率（95%CI）分别为 11.6%（8.0%-15.2%）、5.4%（4.4%-6.5%）、2.5%（1.9%-3.0%）和 3.3%（2.3%-4.3%）。
OAR 术后围手术期使用 BB 与术后死亡率显著降低相关。这是第一项证明 BB 与 OAR 术后死亡率之间存在剂量反应关系的研究。
