School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden.
Division of Traumatology, Surgical Critical Care and Emergency Surgery, Penn Medicine, Penn Presbyterian Medical Center, 19104, Philadelphia, USA.
Sci Rep. 2022 Mar 28;12(1):5279. doi: 10.1038/s41598-022-08736-6.
β-blocker therapy has been positively associated with improved survival in patients undergoing oncologic colorectal resection. This study investigates if the type of β-blocker used affects 90-day postoperative mortality following colon cancer surgery. The study was designed as a nationwide retrospective cohort study including all adult (≥ 18 years old) patients with ongoing β-blocker therapy who underwent elective and emergency colon cancer surgery in Sweden between January 1, 2007 and December 31, 2017. Patients were divided into four cohorts: metoprolol, atenolol, bisoprolol, and other beta-blockers. The primary outcome of interest was 90-day postoperative mortality. A Poisson regression model with robust standard errors was used, while adjusting for all clinically relevant variables, to determine the association between different β-blockers and 90-day postoperative mortality. A total of 9254 patients were included in the study. There was no clinically significant difference in crude 90-day postoperative mortality rate [n (%)] when comparing the four beta-blocker cohorts metoprolol, atenolol, bisoprolol and other beta-blockers. [97 (1.8%) vs. 28 (2.0%) vs. 29 (1.7%) vs. 11 (1.2%), p = 0.670]. This remained unchanged when adjusting for relevant covariates in the Poisson regression model. Compared to metoprolol, there was no statistically significant decrease in the risk of 90-day postoperative mortality with atenolol [adj. IRR (95% CI): 1.45 (0.89-2.37), p = 0.132], bisoprolol [adj. IRR (95% CI): 1.45 (0.89-2.37), p = 0.132], or other beta-blockers [adj. IRR (95% CI): 0.92 (0.46-1.85), p = 0.825]. In patients undergoing colon cancer surgery, the risk of 90-day postoperative mortality does not differ between the investigated types of β-adrenergic blocking agents.
β 受体阻滞剂治疗与接受肿瘤结直肠切除术的患者的生存改善呈正相关。本研究调查了使用的 β 受体阻滞剂类型是否会影响结肠癌手术后 90 天的术后死亡率。该研究设计为全国性回顾性队列研究，纳入 2007 年 1 月 1 日至 2017 年 12 月 31 日期间在瑞典接受择期和紧急结肠癌手术且持续接受β受体阻滞剂治疗的所有成年（≥18 岁）患者。患者分为四组：美托洛尔、阿替洛尔、比索洛尔和其他β受体阻滞剂。主要观察终点为 90 天术后死亡率。采用稳健标准误差的泊松回归模型，同时调整所有临床相关变量，以确定不同β受体阻滞剂与 90 天术后死亡率之间的关系。共纳入 9254 例患者。比较四组β受体阻滞剂（美托洛尔、阿替洛尔、比索洛尔和其他β受体阻滞剂）的粗 90 天术后死亡率[n（%）]无临床显著差异。[97（1.8%）比 28（2.0%）比 29（1.7%）比 11（1.2%），p=0.670]。当在泊松回归模型中调整相关协变量时，结果保持不变。与美托洛尔相比，阿替洛尔[调整后的发病率比（95%可信区间）：1.45（0.89-2.37），p=0.132]、比索洛尔[调整后的发病率比（95%可信区间）：1.45（0.89-2.37），p=0.132]或其他β受体阻滞剂[调整后的发病率比（95%可信区间）：0.92（0.46-1.85），p=0.825]降低 90 天术后死亡率的风险无统计学意义。在接受结肠癌手术的患者中，所研究的β 肾上腺素能阻滞剂类型之间 90 天术后死亡率的风险无差异。
