Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
School of Medical Sciences, Orebro University, Orebro, Sweden.
Br J Surg. 2019 Mar;106(4):477-483. doi: 10.1002/bjs.10988. Epub 2018 Sep 27.
Emergency colorectal cancer surgery is associated with significant mortality. Induced adrenergic hyperactivity is thought to be an important contributor. Downregulating the effects of circulating catecholamines may reduce the risk of adverse outcomes. This study assessed whether regular preoperative beta-blockade reduced mortality after emergency colonic cancer surgery.
This cohort study used the prospectively collected Swedish Colorectal Cancer Registry to recruit all adult patients requiring emergency colonic cancer surgery between 2011 and 2016. Patients were subdivided into those receiving regular beta-blocker therapy before surgery and those who were not (control). Demographics and clinical outcomes were compared. Risk factors for 30-day mortality were evaluated using Poisson regression analysis.
A total of 3187 patients were included, of whom 685 (21·5 per cent) used regular beta-blocker therapy before surgery. The overall 30-day mortality rate was significantly reduced in the beta-blocker group compared with controls: 3·1 (95 per cent c.i. 1·9 to 4·7) versus 8·6 (7·6 to 9·8) per cent respectively (P < 0·001). Beta-blocker therapy was the only modifiable protective factor identified in multivariable analysis of 30-day all-cause mortality (incidence rate ratio 0·31, 95 per cent c.i. 0·20 to 0·47; P < 0·001) and was associated with a significant reduction in death of cardiovascular, respiratory, sepsis and multiple organ failure origin.
Preoperative beta-blocker therapy may be associated with a reduction in 30-day mortality following emergency colonic cancer surgery.
急诊结直肠癌手术与较高的死亡率相关。人们认为，诱导的肾上腺素能活性是一个重要的促成因素。下调循环儿茶酚胺的作用可能会降低不良结局的风险。本研究评估了常规术前β受体阻滞剂治疗是否会降低急诊结肠癌症手术后的死亡率。
这项队列研究使用前瞻性收集的瑞典结直肠癌登记处，招募了 2011 年至 2016 年期间所有需要急诊结肠癌症手术的成年患者。将患者分为手术前接受常规β受体阻滞剂治疗的患者和未接受治疗的患者（对照组）。比较了人口统计学和临床结局。使用泊松回归分析评估了 30 天死亡率的危险因素。
共纳入 3187 例患者，其中 685 例（21.5%）在手术前使用常规β受体阻滞剂治疗。与对照组相比，β受体阻滞剂组的 30 天总死亡率显著降低：分别为 3.1%（95%可信区间 1.9 至 4.7）和 8.6%（7.6 至 9.8）（P<0.001）。在对 30 天全因死亡率的多变量分析中，β受体阻滞剂治疗是唯一可改变的保护因素（发病率比 0.31，95%可信区间 0.20 至 0.47；P<0.001），与心血管、呼吸、脓毒症和多器官衰竭导致的死亡显著减少相关。
术前β受体阻滞剂治疗可能与急诊结肠癌症手术后 30 天死亡率的降低相关。
