Faculty Opinions recommendation of Association of Frailty and 1-Year Postoperative Mortality Following Major Elective Noncardiac Surgery: A Population-Based Cohort Study.

INTRODUCTION: Guidelines recommend that perioperative beta-blockade be started days to weeks before surgery. Nonetheless, all randomized trials except for the controversial DECREASE trials started treatment ≤1 day before surgery, while most observational studies did not distinguish between long-term beta-blockade versus beta-blockers started for perioperative reasons. We thus conducted a population-based cohort study of the effectiveness of beta-blockade started within a clinically sensible period (8-60 days) before surgery. METHODS: Following research ethics approval, we conducted a cohort study of patients (≥66 years) who underwent major elective noncardiac surgery from 2003 and 2012 in Ontario, Canada. Propensity-score methods were used to form a matched cohort that reduced important differences between patients who started beta-blockers 8-60 days before surgery versus controls (no beta-blockers within 1 year before surgery). We measured the association of beta-blockade with 30-day (death, MI, stroke) and 1-year (death) outcomes post-surgery. Subgroup analyses were performed based on Revised Cardiac Risk Index class and history of prior CAD. RESULTS: The cohort included 4268 beta-blocked patients and 154,357 controls. Metoprolol (median daily dose 50 mg) was prescribed to 36% of beta-blocked patients, atenolol (median 25 mg) to 26%, and bisoprolol (median 5 mg) to 37%. In the matched cohort (n=8492), beta-blockade was not associated with death (RR 0.96; CI 0.70-1.32), MI (RR 0.92; CI 0.72-1.17), and stroke (RR 1.31; CI 0.68-2.52) at 30-days, or death at 1-year (Figure). Associations with outcomes did not differ significantly across subgroups. CONCLUSIONS: Outcomes were not altered in patients who start perioperative beta-blockade within a clinically sensible period before surgery. A large randomized trial is needed to determine if the continued use of perioperative beta-blockade in clinical practice is justified.

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Impact of Beta‐Blocker Initiation Timing on Mortality Risk in Patients With Diabetes Mellitus Undergoing Noncardiac Surgery: A Nationwide Population‐Based Cohort Study

Journal of the American Heart Association ◽

10.1161/jaha.116.004392 ◽

2017 ◽

Vol 6 (1) ◽

Cited By ~ 5

Author(s):

Ray‐Jade Chen ◽

Hsi Chu ◽

Lung‐Wen Tsai

Keyword(s):

Diabetes Mellitus ◽

Cohort Study ◽

Mortality Risk ◽

Beta Blocker ◽

Population Based ◽

Noncardiac Surgery ◽

Patients With Diabetes

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Adverse Outcomes After Noncardiac Surgery in Patients With Diabetes: A nationwide population-based retrospective cohort study

Diabetes Care ◽

10.2337/dc13-0770 ◽

2013 ◽

Vol 36 (10) ◽

pp. 3216-3221 ◽

Cited By ~ 44

Author(s):

C.-C. Yeh ◽

C.-C. Liao ◽

Y.-C. Chang ◽

L.-B. Jeng ◽

H.-R. Yang ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Population Based ◽

Noncardiac Surgery ◽

Adverse Outcomes ◽

Patients With Diabetes

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O2 Mortality following elective and emergency colorectal surgery in patients with cirrhosis: a population-based cohort study

British Journal of Surgery ◽

10.1093/bjs/znab282.007 ◽

2021 ◽

Vol 108 (Supplement_5) ◽

Author(s):

A Adiamah ◽

C J Crooks ◽

J S Hammond ◽

P Jepsen ◽

J West ◽

...

Keyword(s):

Liver Cirrhosis ◽

Cohort Study ◽

Proportional Hazards ◽

Postoperative Mortality ◽

Case Fatality ◽

Population Based ◽

Cox Proportional Hazards ◽

Decompensated Cirrhosis ◽

Day Case ◽

Emergency Colectomy

Abstract Introduction This population based cohort study, aimed to quantify the risk of mortality following colectomy in patients with cirrhosis by urgency of surgery and stage of cirrhosis. Method Linked primary and secondary-care electronic healthcare data from England was used to identify all patients undergoing colectomy from January 2001 to December 2017. Patients were classified into three cohorts, non-cirrhotics, compensated cirrhotics and decompensated cirrhosis and followed up for 90-days from the date of surgery. Cox proportional hazards models were used to estimate the hazard ratio (HR) of postoperative mortality. Result A total of 36380 eligible patients were included. Of these, 248(0.7%) had liver cirrhosis and 70% had compensated disease. The proportion undergoing a colectomy who had a diagnosis of cirrhosis increased from 0.40% in 2001 to 1.07% in 2017 (χ2(16, N = 36380)=50.53, P < 0.0001). Following elective colectomy, 90-day case fatality was 4% in non-cirrhotics , 7% in compensated cirrhotics and 10% in decompensated cirrhotics. Following emergency colectomy 90-day case fatality was higher, it was 16% in non-cirrhotics, 35% in compensated cirrhotics and 41% in decompensated cirrhotics. This corresponded to an adjusted 2-fold (HR 2.57(95% CI 1.75–3.76)) and 3-fold (3.43(95% CI 2.02–5.83)) increased mortality rate in compensated and decompensated cirrhotics respectively compared to non-cirrhotics following emergency colectomy. Conclusion Over the study period, the proportion of patients undergoing colectomy who had liver cirrhosis increased to 1 in every 100 colectomies. The 90-day case fatality rates were high in all patients with cirrhosis in both emergency and elective settings but the greatest mortality risk was seen in those with decompensation following emergency surgery. Take-home Message 1 in 100 colectomy procedures are in patients with cirrhosis. These cirrhotic patients have a very high risk of postoperative mortality, especially, emergency colectomy in patients with decompensated cirrhosis.

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