Review: In noncardiac surgery, β-blockers started before surgery increase 30-day mortality

摘要

Commentary Practice recommendations for perioperative (3-blockade are most compelling for continuation of preexisting therapy (1); however, perioperative (3-blockade is controversial, particularly amid recent allegations of scientific misconduct in the perioperative community .Recognizing the potential impact of such allegations, Bouri and colleagues performed a meta-analysis of RCTs of initiation of beta-blockers before noncardiac surgery, excluding trials from the discredited DECREASE program. Meta-analysis of the 9 "secure" trials showed that (3-blockade initiated before surgery resulted in a 27% increase in mortality. 79% of patients in the meta-analysis were from the POISE trial, which administered extended-release metoprolol, 100 mg, 2 to 4 hours before surgery; this is rarely done in the perioperative setting. More commonly, (3-blockade is initiated and appropriately titrated weeks in advance of surgery. Bouri and colleagues concluded that "guideline bodies should retract their recommendations based on fictitious data without further delay."