• Haytham M A Kaafarani, Prasad V Atluri, John Thornby, and Kamal M F Itani.
• Department of Surgery, Veterans Affairs Boston Healthcare System (112), 1400 VFW Pkwy, West Roxbury, MA 02132, USA.
• Arch Surg. 2008 Oct 1;143(10):940-4; discussion 944.

HypothesisWe hypothesized that the relationship among beta-blocker use, heart rate control, and perioperative cardiovascular outcome would be similar in patients at all levels of cardiac risk.DesignRetrospective cohort study.SettingMichael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.PatientsAmong all patients who underwent various noncardiac surgical procedures in 2000, those who received perioperative beta-blockers were matched and compared with a control group from the same patient population.Main Outcome MeasuresThirty-day stroke, cardiac arrest, myocardial infarction, and mortality, as well as mortality at 1 year.ResultsPatients at all levels of cardiac risk who received beta-blockers had lower preoperative and intraoperative heart rates. The beta-blocker group had higher rates of 30-day myocardial infarction (2.94% vs 0.74%, P =.03) and 30-day mortality (2.52% vs 0.25%, P =.007) compared with the control group. In the beta-blocker group, patients who died perioperatively had significantly higher preoperative heart rate (86 vs 70 beats/min, P =.03). None of the deaths occurred among the patients at high cardiac risk.ConclusionAmong patients at all levels of cardiac risk undergoing noncardiac surgery, administration of beta-blockers should achieve adequate heart rate control and should be carefully monitored in patients who are not at high cardiac risk.

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