In this issue of Anesthesiology, McKenzie et al.1 address the question: “Is β-blocker initiation within 60 days (but more than 1 day) of major abdominal surgery associated with an increase in postoperative stroke?” They did so by using the Truven database, which provided a large U.S.-based dataset of mostly non-Medicare patients. Their question builds on more than 20 yr of controversy and changing opinion about the role of β-blockers initiated preoperatively and continued throughout the perioperative period.
Of the more than 100 million adults who undergo inpatient, noncardiac surgery globally each year,2 2% develop major cardiac complications and 13% develop prognostically important myocardial injury, both of which have been shown to negatively impact patients’ short- and long-term outcomes.3 Based on the belief that postoperative cardiac events were caused by the sympathetic response to surgery, a small, single-center randomized controlled trial initiated 5 mg oral bisoprolol in...
