• Husain N Alshaikh, Joseph K Canner, and Mahmoud Malas.
• The Johns Hopkins Surgery Center for Outcomes Research (JSCOR), Johns Hopkins School of Medicine, Baltimore, MD.
• Ann. Surg. 2018 Jun 1; 267 (6): 1185-1190.

ObjectiveTo assess the effect of perioperative beta blocker (BB) use on postoperative in-hospital mortality after open repair of abdominal aortic aneurysm (OAR).BackgroundPostoperative mortality after OAR ranges from 3.0% to 4.5%. Insight about the effect of BBs on postoperative mortality after OAR is currently lacking.MethodsThis 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.ResultsOf 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.ConclusionsIn-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.

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