Effect of Beta Blockers on Mortality after Open Repair of Abdominal Aortic Aneurysm

Husain N. Alshaikh, Joseph K. Canner, Mahmoud Malas

Research output: Contribution to journalArticle

Abstract

Objective: To assess the effect of perioperative beta blocker (BB) use on postoperative in-hospital mortality after open repair of abdominal aortic aneurysm (OAR). Background: Postoperative mortality after OAR ranges from 3.0% to 4.5%. Insight about the effect of BBs on postoperative mortality after OAR is currently lacking. Methods: This 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. Results: Of 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. Conclusions: In-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.

Original languageEnglish (US)
Pages (from-to)1185-1190
Number of pages6
JournalAnnals of Surgery
Volume267
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Abdominal Aortic Aneurysm
Mortality
Logistic Models
Confidence Intervals
Hospital Mortality
Odds Ratio
Databases
Delivery of Health Care
Inpatients
Coronary Artery Disease
Retrospective Studies
Wounds and Injuries

Keywords

  • beta blockers
  • intact AAA
  • open repair
  • postoperative mortality
  • Premier Healthcare Database

ASJC Scopus subject areas

  • Surgery

Cite this

Effect of Beta Blockers on Mortality after Open Repair of Abdominal Aortic Aneurysm. / Alshaikh, Husain N.; Canner, Joseph K.; Malas, Mahmoud.

In: Annals of Surgery, Vol. 267, No. 6, 01.06.2018, p. 1185-1190.

Research output: Contribution to journalArticle

Alshaikh, Husain N. ; Canner, Joseph K. ; Malas, Mahmoud. / Effect of Beta Blockers on Mortality after Open Repair of Abdominal Aortic Aneurysm. In: Annals of Surgery. 2018 ; Vol. 267, No. 6. pp. 1185-1190.
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abstract = "Objective: To assess the effect of perioperative beta blocker (BB) use on postoperative in-hospital mortality after open repair of abdominal aortic aneurysm (OAR). Background: Postoperative mortality after OAR ranges from 3.0{\%} to 4.5{\%}. Insight about the effect of BBs on postoperative mortality after OAR is currently lacking. Methods: This 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. Results: Of 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. Conclusions: In-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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N2 - Objective: To assess the effect of perioperative beta blocker (BB) use on postoperative in-hospital mortality after open repair of abdominal aortic aneurysm (OAR). Background: Postoperative mortality after OAR ranges from 3.0% to 4.5%. Insight about the effect of BBs on postoperative mortality after OAR is currently lacking. Methods: This 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. Results: Of 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. Conclusions: In-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.

AB - Objective: To assess the effect of perioperative beta blocker (BB) use on postoperative in-hospital mortality after open repair of abdominal aortic aneurysm (OAR). Background: Postoperative mortality after OAR ranges from 3.0% to 4.5%. Insight about the effect of BBs on postoperative mortality after OAR is currently lacking. Methods: This 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. Results: Of 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. Conclusions: In-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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