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Stenberg E, Mohseni S, Cao Y, Näslund E. Limited Effect of Beta-blockade on Postoperative Outcome After Laparoscopic Gastric Bypass Surgery. Obes Surg 2020; 30:139-145. [PMID: 31346982 DOI: 10.1007/s11695-019-04108-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The benefit of beta-blockade on postoperative outcome remains controversial, though recent studies have suggested a role during major non-cardiac surgery. The benefit of beta-blockade during minimally invasive gastric bypass surgery remains unclear. The aim of the present study was to evaluate the possible association between preoperative beta-blocker therapy and postoperative outcome after laparoscopic gastric bypass surgery. METHODS Patients operated with primary laparoscopic gastric bypass surgery in Sweden between 2007 and 2017 were identified through the Scandinavian Obesity Surgery Registry. The dataset was linked to the Swedish National Patient Registry, the Swedish Prescribed Drug Registry, and Statistics Sweden. The main outcome was serious postoperative complication within 30 days of surgery; with postoperative complication, 90-day and 1-year mortality, and weight loss at 2 years after surgery as secondary endpoints. The Poisson regression model was used to evaluate primary and secondary categorical outcomes. A general mixed model was performed to evaluate 2-year weight loss. RESULTS In all, 50281 patients were included in the study. No difference was seen between patients on beta-blockade and the control group regarding postoperative complications (adjusted incidence rate ratio 1.04 (95%CI 0.93-1.15), p = 0.506), serious postoperative complication (adjusted IRR 1.06 95%CI 0.89-1.27), p = 0.515), 90-day mortality (adjusted IRR 0.71 (95%CI 0.24-2.10), p = 0.537), and 1-year mortality (adjusted IRR 1.26 (95%CI 0.67-2.36), p = 0.467). Weight loss 2 years after surgery was slightly greater in patients on beta-blockade (adjusted coefficient 0.53 (95%CI 0.19-0.87), p = 0.002). CONCLUSIONS Beta-blockade has limited impact on postoperative outcome after laparoscopic gastric bypass surgery.
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Affiliation(s)
- Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-70185, Örebro, Sweden.
| | - Shahin Mohseni
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-70185, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Erik Näslund
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
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Leslie K, Myles PS, Halliwell R, Paech MJ, Short TG, Walker S. Beta-Blocker management in High-Risk Patients Presenting for Non-Cardiac Surgery: Before and after the POISE Trial. Anaesth Intensive Care 2012; 40:319-27. [DOI: 10.1177/0310057x1204000216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The POISE Trial was a randomised, placebo-controlled, double-blind study of the effectiveness of perioperative beta-blockade in preventing cardiac events including death in 8351 patients. Our hypothesis was that knowledge of the results of the POISE Trial would either increase or decrease the use of effective perioperative beta-blockade, depending on the result. Patients presenting for non-cardiac surgery and at risk of perioperative cardiac events were recruited in two cohorts before and after the release of the POISE Trial results. Effective perioperative beta-blockade was defined as heart rate <65 beats per minute for at least 80% of the perioperative period in patients prescribed beta-blockers. Effective perioperative beta-blockade was achieved in 22 (11.5%) of 191 patients prescribed perioperative beta-blockade in the first cohort (n=392) and seven (6%) of 118 patients in the second cohort (n=241) (P=0.10). Effective heart rate control was achieved in 29 (9%) patients prescribed perioperative beta-blockers compared with 10 (3%) patients not prescribed perioperative beta-blockers (P=0.001). The rate of implementation of effective beta-blockade was low before POISE and this did not change significantly after publication. Our finding does not provide reliable evidence of a change in practice as a result of the POISE Trial.
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Affiliation(s)
- K. Leslie
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital; Department of Pharmacology, University of Melbourne; Department of Epidemiology and Preventive Medicine, Monash University; Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Academic Board of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Victoria; National Health and Medical Research Council, Canberra, Australian Capital Territory; Department of Anaesthesia, Westmead Hospital, Sydney,
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital; Honorary Professorial Fellow, Department of Pharmacology, University of Melbourne and Honorary Adjunct Professor, Department of Epidemiology and Preventive Medicine
| | - P. S. Myles
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital; Department of Pharmacology, University of Melbourne; Department of Epidemiology and Preventive Medicine, Monash University; Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Academic Board of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Victoria; National Health and Medical Research Council, Canberra, Australian Capital Territory; Department of Anaesthesia, Westmead Hospital, Sydney,
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital; Professor, Academic Board of Anaesthesia and Perioperative Medicine, Monash University and Practitioner Fellow, National Health and Medical Research Council, Canberra, Australian Capital Territory
| | - R. Halliwell
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital; Department of Pharmacology, University of Melbourne; Department of Epidemiology and Preventive Medicine, Monash University; Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Academic Board of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Victoria; National Health and Medical Research Council, Canberra, Australian Capital Territory; Department of Anaesthesia, Westmead Hospital, Sydney,
- Department of Anaesthesia, Westmead Hospital, Sydney, New South Wales
| | - M. J. Paech
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital; Department of Pharmacology, University of Melbourne; Department of Epidemiology and Preventive Medicine, Monash University; Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Academic Board of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Victoria; National Health and Medical Research Council, Canberra, Australian Capital Territory; Department of Anaesthesia, Westmead Hospital, Sydney,
- School of Medicine and Pharmacology, University of Western Australia and Consultant Anaesthetist, Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Perth, Western Australia
| | - T. G. Short
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital; Department of Pharmacology, University of Melbourne; Department of Epidemiology and Preventive Medicine, Monash University; Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Academic Board of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Victoria; National Health and Medical Research Council, Canberra, Australian Capital Territory; Department of Anaesthesia, Westmead Hospital, Sydney,
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - S. Walker
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital; Department of Pharmacology, University of Melbourne; Department of Epidemiology and Preventive Medicine, Monash University; Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Academic Board of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Victoria; National Health and Medical Research Council, Canberra, Australian Capital Territory; Department of Anaesthesia, Westmead Hospital, Sydney,
- Department of Anaesthesia, Middlemore Hospital, Auckland, New Zealand
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