Preoperative beta-blocker use should not be a quality metric for coronary artery bypass grafting

Damien J. Lapar, Ivan K. Crosby, Irving L. Kron, John A. Kern, Edwin Fonner, Jeffrey B. Rich, Alan M. Speir, Gorav Ailawadi

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background Preoperative beta-blockade for coronary artery bypass grafting (CABG) has become an accepted hospital quality metric. However, single-institution reports regarding the benefits of beta-blocker (ß-blocker) use are conflicting. The purpose of this study was to evaluate the associations between preoperative beta-blocker use and outcomes within a large, regional cohort. Methods Patient records from a statewide, multi-institutional Society of Thoracic Surgeons (STS) certified database for isolated CABG operations (2001 to 2011) were extracted and stratified by preoperative ß-blocker use. The influence of preoperative ß-blockers on risk-adjusted outcomes was assessed by hierarchical regression modeling with adjustment for preoperative risk using calculated STS predictive risk indices. Results A total of 43,747 (age, 63 years; ß-blocker 80% versus non ß-blocker 20%) patients were included. Median STS predicted risk of mortality scores for ß-blocker patients were incrementally lower (1.2% vs 1.4%, p < 0.001). Non ß-blocker patients more frequently developed pneumonia (3.5% vs 2.8%, p = 0.001), while ß-blocker patients surprisingly had greater intraoperative blood usage (16% vs 11%, p < 0.001). There was no difference in unadjusted mortality (ß-blocker: 1.9% vs non ß-blocker: 2.2%, p = 0.15). After risk adjustment, preoperative ß-blocker use was not associated with mortality (p = 0.63), morbidity, length of stay (p = 0.79), or hospital readmission (p = 0.97). Conclusions Preoperative ß-blocker use is not associated with risk-adjusted mortality, several measures of morbidity, or hospital resource utilization after CABG operations. Thus, these data suggest that the routine use of preoperative ß-blockers for CABG operations should not be used as a measure of surgical quality.

Original languageEnglish (US)
Pages (from-to)1539-1545
Number of pages7
JournalAnnals of Thoracic Surgery
Volume96
Issue number5
DOIs
StatePublished - Nov 1 2013
Externally publishedYes

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Preoperative Care
Adrenergic beta-Antagonists
Health Care Quality Indicators
Coronary Artery Bypass
Risk Adjustment
Thorax
Mortality
Morbidity
Patient Readmission
Length of Stay
Pneumonia
Databases

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Preoperative beta-blocker use should not be a quality metric for coronary artery bypass grafting. / Lapar, Damien J.; Crosby, Ivan K.; Kron, Irving L.; Kern, John A.; Fonner, Edwin; Rich, Jeffrey B.; Speir, Alan M.; Ailawadi, Gorav.

In: Annals of Thoracic Surgery, Vol. 96, No. 5, 01.11.2013, p. 1539-1545.

Research output: Contribution to journalArticle

Lapar, DJ, Crosby, IK, Kron, IL, Kern, JA, Fonner, E, Rich, JB, Speir, AM & Ailawadi, G 2013, 'Preoperative beta-blocker use should not be a quality metric for coronary artery bypass grafting', Annals of Thoracic Surgery, vol. 96, no. 5, pp. 1539-1545. https://doi.org/10.1016/j.athoracsur.2013.05.059
Lapar, Damien J. ; Crosby, Ivan K. ; Kron, Irving L. ; Kern, John A. ; Fonner, Edwin ; Rich, Jeffrey B. ; Speir, Alan M. ; Ailawadi, Gorav. / Preoperative beta-blocker use should not be a quality metric for coronary artery bypass grafting. In: Annals of Thoracic Surgery. 2013 ; Vol. 96, No. 5. pp. 1539-1545.
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abstract = "Background Preoperative beta-blockade for coronary artery bypass grafting (CABG) has become an accepted hospital quality metric. However, single-institution reports regarding the benefits of beta-blocker ({\ss}-blocker) use are conflicting. The purpose of this study was to evaluate the associations between preoperative beta-blocker use and outcomes within a large, regional cohort. Methods Patient records from a statewide, multi-institutional Society of Thoracic Surgeons (STS) certified database for isolated CABG operations (2001 to 2011) were extracted and stratified by preoperative {\ss}-blocker use. The influence of preoperative {\ss}-blockers on risk-adjusted outcomes was assessed by hierarchical regression modeling with adjustment for preoperative risk using calculated STS predictive risk indices. Results A total of 43,747 (age, 63 years; {\ss}-blocker 80{\%} versus non {\ss}-blocker 20{\%}) patients were included. Median STS predicted risk of mortality scores for {\ss}-blocker patients were incrementally lower (1.2{\%} vs 1.4{\%}, p < 0.001). Non {\ss}-blocker patients more frequently developed pneumonia (3.5{\%} vs 2.8{\%}, p = 0.001), while {\ss}-blocker patients surprisingly had greater intraoperative blood usage (16{\%} vs 11{\%}, p < 0.001). There was no difference in unadjusted mortality ({\ss}-blocker: 1.9{\%} vs non {\ss}-blocker: 2.2{\%}, p = 0.15). After risk adjustment, preoperative {\ss}-blocker use was not associated with mortality (p = 0.63), morbidity, length of stay (p = 0.79), or hospital readmission (p = 0.97). Conclusions Preoperative {\ss}-blocker use is not associated with risk-adjusted mortality, several measures of morbidity, or hospital resource utilization after CABG operations. Thus, these data suggest that the routine use of preoperative {\ss}-blockers for CABG operations should not be used as a measure of surgical quality.",
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T1 - Preoperative beta-blocker use should not be a quality metric for coronary artery bypass grafting

AU - Lapar, Damien J.

AU - Crosby, Ivan K.

AU - Kron, Irving L.

AU - Kern, John A.

AU - Fonner, Edwin

AU - Rich, Jeffrey B.

AU - Speir, Alan M.

AU - Ailawadi, Gorav

PY - 2013/11/1

Y1 - 2013/11/1

N2 - Background Preoperative beta-blockade for coronary artery bypass grafting (CABG) has become an accepted hospital quality metric. However, single-institution reports regarding the benefits of beta-blocker (ß-blocker) use are conflicting. The purpose of this study was to evaluate the associations between preoperative beta-blocker use and outcomes within a large, regional cohort. Methods Patient records from a statewide, multi-institutional Society of Thoracic Surgeons (STS) certified database for isolated CABG operations (2001 to 2011) were extracted and stratified by preoperative ß-blocker use. The influence of preoperative ß-blockers on risk-adjusted outcomes was assessed by hierarchical regression modeling with adjustment for preoperative risk using calculated STS predictive risk indices. Results A total of 43,747 (age, 63 years; ß-blocker 80% versus non ß-blocker 20%) patients were included. Median STS predicted risk of mortality scores for ß-blocker patients were incrementally lower (1.2% vs 1.4%, p < 0.001). Non ß-blocker patients more frequently developed pneumonia (3.5% vs 2.8%, p = 0.001), while ß-blocker patients surprisingly had greater intraoperative blood usage (16% vs 11%, p < 0.001). There was no difference in unadjusted mortality (ß-blocker: 1.9% vs non ß-blocker: 2.2%, p = 0.15). After risk adjustment, preoperative ß-blocker use was not associated with mortality (p = 0.63), morbidity, length of stay (p = 0.79), or hospital readmission (p = 0.97). Conclusions Preoperative ß-blocker use is not associated with risk-adjusted mortality, several measures of morbidity, or hospital resource utilization after CABG operations. Thus, these data suggest that the routine use of preoperative ß-blockers for CABG operations should not be used as a measure of surgical quality.

AB - Background Preoperative beta-blockade for coronary artery bypass grafting (CABG) has become an accepted hospital quality metric. However, single-institution reports regarding the benefits of beta-blocker (ß-blocker) use are conflicting. The purpose of this study was to evaluate the associations between preoperative beta-blocker use and outcomes within a large, regional cohort. Methods Patient records from a statewide, multi-institutional Society of Thoracic Surgeons (STS) certified database for isolated CABG operations (2001 to 2011) were extracted and stratified by preoperative ß-blocker use. The influence of preoperative ß-blockers on risk-adjusted outcomes was assessed by hierarchical regression modeling with adjustment for preoperative risk using calculated STS predictive risk indices. Results A total of 43,747 (age, 63 years; ß-blocker 80% versus non ß-blocker 20%) patients were included. Median STS predicted risk of mortality scores for ß-blocker patients were incrementally lower (1.2% vs 1.4%, p < 0.001). Non ß-blocker patients more frequently developed pneumonia (3.5% vs 2.8%, p = 0.001), while ß-blocker patients surprisingly had greater intraoperative blood usage (16% vs 11%, p < 0.001). There was no difference in unadjusted mortality (ß-blocker: 1.9% vs non ß-blocker: 2.2%, p = 0.15). After risk adjustment, preoperative ß-blocker use was not associated with mortality (p = 0.63), morbidity, length of stay (p = 0.79), or hospital readmission (p = 0.97). Conclusions Preoperative ß-blocker use is not associated with risk-adjusted mortality, several measures of morbidity, or hospital resource utilization after CABG operations. Thus, these data suggest that the routine use of preoperative ß-blockers for CABG operations should not be used as a measure of surgical quality.

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