Early Resumption of β Blockers Is Associated with Decreased Atrial Fibrillation after Noncardiothoracic and Nonvascular Surgery: A Cohort Analysis. (December 2018)

• Record Type: Journal Article
• Authors: Khanna, Ashish K.; Naylor, Douglas F.; Naylor, Amanda J.; Mascha, Edward J.; You, Jing; Reville, Eric M.; Riter, Quinton M.; Diwan, Murtaza; Kurz, Andrea; Sessler, Daniel I.
• Is Part Of: Anesthesiology. Volume 129:Number 6(2018)
• Publication Date: 2018-12
• Subjects: Anesthesiology -- Periodicals; Anesthetics -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1097/ALN.0000000000002457
• Languages: English
• ISSNs: 0003-3022

Abstract

Editor's Perspective: What We Already Know about This Topic: Use of beta (β) blockers in the perioperative period is associated with reduced incidence of postoperative atrial fibrillation In chronic β-blocker users, optimal timing for β-blocker resumption in the postoperative setting is unclear What This Article Tells Us That Is New: Resumption of postoperative β-blocker therapy by the end of postoperative day 1 is associated with reduced incidence of postoperative atrial fibrillation in general surgical patients (noncardiac, nonthoracic, nonvascular surgeries) when compared with patients who resumed β-blocker therapy after postoperative day 1 There was not a significant difference in incidence of postoperative atrial fibrillation for those patients who postoperatively resumed β-blocker therapy on the day of surgery versus anytime thereafter 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. Methods: The 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. Results: Of 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). Conclusions: Resuming 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. Abstract : Resumption of postoperative β-blocker therapy by the end of postoperative day 1 is associated with reduced incidence of postoperative atrial fibrillation in general surgical patients (noncardiac, nonthoracic, nonvascular surgeries) when compared with patients who resumed β-blocker therapy after postoperative day 1. There was not a significant difference in incidence of postoperative atrial fibrillation for those patients who postoperatively resumed β-blocker therapy on the day of surgery versus anytime thereafter.