Center for Trauma and Critical Care, Department of Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, Orebro, Sweden.
Scand J Surg. 2021 Mar;110(1):37-43. doi: 10.1177/1457496919877582. Epub 2019 Sep 23.
Emergency laparotomy is associated with a great risk of mortality in the elderly. The hyperadrenergic state induced by surgical trauma may play an important role in the pathophysiology of this increased risk. Studies have shown that beta-blocker exposure may be associated with decreased morbidity and mortality in the perioperative period. We aimed to study the effect of beta-blocker on mortality in geriatric patients undergoing emergency laparotomy.
This is a retrospective study of patients who underwent emergency laparotomy between 1 January 2015 and 31 December 2016 at a single institution. The outcomes of interest were the association between post-operative complications and in-hospital and 1-year mortality in patients on beta-blocker therapy (BB) and those who were not (BB). The Poisson regression analysis was used to evaluate the association.
A total of 192 patients were included of whom 62 (32.2%) had pre-operative beta-blocker therapy with continued exposure during their hospital stay. The in-hospital mortality was 17.7% in the BB and 23.8% in the BB cohorts ( = 0.441). One-year mortality was significantly lower in the BB group compared to the BB group (30.6% versus 47.7%; = 0.038). After adjusting for confounders, the incidence of deaths during 1 year post-operatively decreased by 35% in the BB group (incidence rate ratio = 0.65, = 0.004). No significant differences in the incidence of post-operative complications between the two groups could be measured.
Beta-blocker therapy may be associated with reduced 1-year mortality following emergency laparotomy in geriatric patients.
老年患者行急诊剖腹手术后的死亡率较高，而手术创伤引起的高肾上腺素能状态可能在这种风险增加的病理生理学中发挥重要作用。研究表明，β受体阻滞剂的使用可能与围手术期发病率和死亡率降低有关。本研究旨在探讨β受体阻滞剂对行急诊剖腹手术的老年患者死亡率的影响。
这是一项回顾性研究，纳入了 2015 年 1 月 1 日至 2016 年 12 月 31 日在一家医疗机构行急诊剖腹手术的患者。主要观察终点为术后并发症以及β受体阻滞剂（BB）治疗组和未治疗组患者的院内和 1 年死亡率。采用泊松回归分析评估相关性。
共纳入 192 例患者，其中 62 例（32.2%）术前接受β受体阻滞剂治疗，住院期间持续暴露于该药物。BB 组的院内死亡率为 17.7%，BB 组为 23.8%（ = 0.441）。BB 组的 1 年死亡率明显低于 BB 组（30.6%比 47.7%； = 0.038）。调整混杂因素后，BB 组术后 1 年内的死亡率降低了 35%（发生率比 = 0.65， = 0.004）。两组患者术后并发症的发生率无显著差异。
β受体阻滞剂治疗可能与老年患者急诊剖腹手术后 1 年死亡率降低有关。
