ABSTRACT
BACKGROUND: Emergency colorectal cancer surgery is associated with significant mortality. Induced adrenergic hyperactivity is thought to be an important contributor. Downregulating the effects of circulating catecholamines may reduce the risk of adverse outcomes. This study assessed whether regular preoperative beta-blockade reduced mortality after emergency colonic cancer surgery. METHODS: This cohort study used the prospectively collected Swedish Colorectal Cancer Registry to recruit all adult patients requiring emergency colonic cancer surgery between 2011 and 2016. Patients were subdivided into those receiving regular beta-blocker therapy before surgery and those who were not (control). Demographics and clinical outcomes were compared. Risk factors for 30-day mortality were evaluated using Poisson regression analysis. RESULTS: A total of 3187 patients were included, of whom 685 (21·5 per cent) used regular beta-blocker therapy before surgery. The overall 30-day mortality rate was significantly reduced in the beta-blocker group compared with controls: 3·1 (95 per cent c.i. 1·9 to 4·7) versus 8·6 (7·6 to 9·8) per cent respectively (P < 0·001). Beta-blocker therapy was the only modifiable protective factor identified in multivariable analysis of 30-day all-cause mortality (incidence rate ratio 0·31, 95 per cent c.i. 0·20 to 0·47; P < 0·001) and was associated with a significant reduction in death of cardiovascular, respiratory, sepsis and multiple organ failure origin. CONCLUSION: Preoperative beta-blocker therapy may be associated with a reduction in 30-day mortality following emergency colonic cancer surgery.
Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Colectomy/mortality , Colonic Neoplasms/mortality , Colonic Neoplasms/surgery , Registries , Adult , Age Factors , Aged , Cohort Studies , Colectomy/methods , Colonic Neoplasms/pathology , Emergencies , Female , Humans , Male , Markov Chains , Middle Aged , Postoperative Complications/mortality , Postoperative Complications/prevention & control , Preoperative Care , Retrospective Studies , Risk Assessment , Sex Factors , Statistics, Nonparametric , Survival Rate , Sweden , Treatment OutcomeABSTRACT
PURPOSE: Severe traumatic brain injury (TBI) is the predominant cause of death and disability following trauma. Several studies have observed improved survival in TBI patients exposed to ß-blockers, however, the effect on functional outcome is poorly documented. METHODS: Adult patients with severe TBI (head AIS ≥ 3) were identified from a prospectively collected TBI database over a 5-year period. Patients with neurosurgical ICU length of stay <48 h and those dying within 48 h of admission were excluded. Patients exposed to ß-blockers ≤ 48 h after admission and who continued with treatment until discharge constituted ß-blocked cases and were matched to non ß-blocked controls using propensity score matching. The outcome of interest was Glasgow Outcome Scores (GOS), as a measure of functional outcome up to 12 months after injury. GOS ≤ 3 was considered a poor outcome. Bivariate analysis was deployed to determine differences between groups. Odds ratio and 95% CI were used to assess the effect of ß-blockers on GOS. RESULTS: 362 patients met the inclusion criteria with 21% receiving ß-blockers during admission. After propensity matching, 76 matched pairs were available for analysis. There were no statistical differences in any variables included in the analysis. Mean hospital length of stay was shorter in the ß-blocked cases (18.0 vs. 26.8 days, p < 0.01). The risk of poor long-term functional outcome was more than doubled in non-ß-blocked controls (OR 2.44, 95% CI 1.01-6.03, p = 0.03). CONCLUSION: Exposure to ß-blockers in patients with severe TBI appears to improve functional outcome. Further prospective randomized trials are warranted.
