Perioperative β-blocker withdrawal and mortality in vascular surgical patients

Objective: Our purpose was to determine the effect of postoperative β-blocker withdrawal on mortality and cardiovascular events after vascular surgery. Methods: Detailed data were collected on perioperative cardiovascular medication use and discontinuation and cardiovascular risk factors among consecutive major vascular surgical procedures at two university hospitals. Results: A total of 140 patients received β-blockers preoperatively. Mortality in the 8 patients who had β-blockers discontinued postoperatively (50%) was significantly greater than in 132 patients who had β-blockers continued (1.5%, odds ratio 65.0, P < .001). The effect of β-blocker discontinuation was unaffected by adjustment by stratification for risk factors (all P ≤ .01), for contraindications to restarting β-blockers (P = .006), and by multivariable analyses adjusting for potential confounders (adjusted odds ratio 17.0, P = .01). β-Blocker discontinuation also was associated with increased cardiovascular mortality (0% vs 29%, P = .005) and postoperative myocardial infarction (odds ratio 17.7, P = .003). Conclusion: Discontinuing β-blockers immediately after vascular surgery may increase the risk of postoperative cardiovascular morbidity and mortality.