Objective To determine the effect of perioperative blocker
treatment in
patients having non-
cardiac surgery . Design
Systematic review and
meta-analysis .
Data sources Seven search
strategies , including searching two
bibliographic databases and
hand searching seven medical journals.Study selection and outcomes We included randomised controlled trials that evaluated blocker
treatment in
patients having non-
cardiac surgery . Perioperative outcomes within 30 days of
surgery included total
mortality , cardiovascular
mortality , non-fatal
myocardial infarction , non-fatal
cardiac arrest , non-fatal
stroke ,
congestive heart failure ,
hypotension needing
treatment ,
bradycardia needing
treatment , and
bronchospasm . Results Twenty two trials that randomised a total of 2437
patients met the eligibility criteria. Perioperative blockers did not show any statistically significant beneficial effects on any of the individual outcomes and the only nominally statistically significant beneficial
relative risk was 0.44 (95%
confidence interval 0.20 to 0.97, 99%
confidence interval 0.16 to 1.24) for the composite outcome of cardiovascular
mortality , non-fatal
myocardial infarction , and non-fatal
cardiac arrest .
Methods adapted from formal interim
monitoring boundaries applied to cumulative
meta-analysis showed that the evidence failed, by a considerable degree, to meet
standards for forgoing additional studies. The individual
safety outcomes in
patients treated with perioperative blockers showed a
relative risk for
bradycardia needing
treatment of 2.27 (95% CI 1.53 to 3.36, 99% CI 1.36 to 3.80) and a nominally statistically significant
relative risk for
hypotension needing
treatment of 1.27 (95% CI 1.04 to 1.56, 99% CI 0.97 to 1.66). Conclusion The evidence that perioperative blockers reduce major cardiovascular events is encouraging but too unreliable to allow definitive conclusions to be drawn...