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Anesthesiology ; 129(6): 1101-1110, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30300157

RESUMO

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Beta (ß) blockers reduce the risk of postoperative atrial fibrillation and should be restarted after surgery, but it remains unclear when best to resume ß blockers postoperatively. The authors thus evaluated the relationship between timing of resumption of ß blockers and atrial fibrillation in patients recovering from noncardiothoracic and nonvascular surgery. METHODS: The authors evaluated 8,201 adult ß-blocker users with no previous history of atrial fibrillation who stayed at least two nights after noncardiothoracic and nonvascular surgery as a retrospective observational cohort. After propensity score matching on baseline and intraoperative variables, 1,924 patients who did resume ß blockers by the end of postoperative day 1 were compared with 973 patients who had not resumed by that time on postoperative atrial fibrillation using logistic regression. A secondary matched analysis compared 3,198 patients who resumed ß blockers on the day of surgery with 3,198 who resumed thereafter. RESULTS: Of propensity score-matched patients who resumed ß blockers by end of postoperative day 1, 4.9% (94 of 1,924) developed atrial fibrillation, compared with 7.0% (68 of 973) of those who resumed thereafter (adjusted odds ratio, 0.69; 95% CI, 0.50-0.95; P = 0.026). Patients who resumed ß blockers on day of surgery had an atrial fibrillation incidence of 4.9% versus 5.8% for those who started thereafter (odds ratio, 0.84; 95% CI, 0.67-1.04; P = 0.104). CONCLUSIONS: Resuming ß blockers in chronic users by the end of the first postoperative day may be associated with lower odds of in-hospital atrial fibrillation. However, there seems to be little advantage to restarting on the day of surgery itself.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Fibrilação Atrial/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Operatórios , Idoso , Fibrilação Atrial/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Pontuação de Propensão , Estudos Retrospectivos
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