• Ashish K Khanna, Douglas F Naylor, Amanda J Naylor, Edward J Mascha, Jing You, Eric M Reville, Quinton M Riter, Murtaza Diwan, Andrea Kurz, and Daniel I Sessler.
• From the Surgical Intensive Care Unit, Center for Critical Care (A.K.K., D.F.N.) Department of Outcomes Research (A.K.K., A.J.N., E.J.M., J.Y., E.M.R., Q.M.R., D.I.S.) Department of Quantitative Health Sciences (E.J.M., J.Y.) Department of General Anesthesia (A.K.), Cleveland Clinic, Cleveland, Ohio University of Michigan Health System, Ann Arbor, Michigan (M.D.).
• Anesthesiology. 2018 Dec 1; 129 (6): 1101-1110.

What We Already Know About This TopicWHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Beta (β) blockers reduce the risk of postoperative atrial fibrillation and should be restarted after surgery, but it remains unclear when best to resume β blockers postoperatively. The authors thus evaluated the relationship between timing of resumption of β blockers and atrial fibrillation in patients recovering from noncardiothoracic and nonvascular surgery.MethodsThe authors evaluated 8,201 adult β-blocker users with no previous history of atrial fibrillation who stayed at least two nights after noncardiothoracic and nonvascular surgery as a retrospective observational cohort. After propensity score matching on baseline and intraoperative variables, 1,924 patients who did resume β blockers by the end of postoperative day 1 were compared with 973 patients who had not resumed by that time on postoperative atrial fibrillation using logistic regression. A secondary matched analysis compared 3,198 patients who resumed β blockers on the day of surgery with 3,198 who resumed thereafter.ResultsOf propensity score-matched patients who resumed β blockers by end of postoperative day 1, 4.9% (94 of 1,924) developed atrial fibrillation, compared with 7.0% (68 of 973) of those who resumed thereafter (adjusted odds ratio, 0.69; 95% CI, 0.50-0.95; P = 0.026). Patients who resumed β blockers on day of surgery had an atrial fibrillation incidence of 4.9% versus 5.8% for those who started thereafter (odds ratio, 0.84; 95% CI, 0.67-1.04; P = 0.104).ConclusionsResuming β blockers in chronic users by the end of the first postoperative day may be associated with lower odds of in-hospital atrial fibrillation. However, there seems to be little advantage to restarting on the day of surgery itself.

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