Impact of prophylactic postoperative β-blockade on post-cardiothoracic surgery length of stay and atrial fibrillation

Background: Previous studies have shown that post-cardiothoracic surgery atrial fibrillation (AF) increases the risk of hospital length of stay (LOS), overall mortality pulmonary edema, and need for a balloon pump. A meta-analysis of 2 previous trials showed a nonsignificant reduction in LOS with postoperative beta-blockers but only encompassed 1200 patients, with few valve surgery patients, and neither study used a hospital within the US. Objective: To evaluate the impact of postoperative beta-blockers on LOS and AR Secondary endpoints of overall mortality, pulmonary edema, and need for an intra-aortic balloon pump (IABP) were also evaluated between groups. Methods: This was a prospective cohort evaluation of all patients undergoing cardiothoracic surgery at our institution between October 1999 and October 2003. Patients receiving prophylactic postoperative beta-blockers were matched (1:1) with patients not receiving prophylaxis for age >70 years, valvular surgery, history of AF, gender, and use of preoperative digoxin and beta-blockers. Results: Patients (n=1660) receiving postoperative beta-blockade had a reduction in LOS (mean+/-SD 10.22+/-11.38 vs 12.40+/-15.67; p=0.001) and AF(23.5% vs 28.4%; p=0.02). Mortality pulmonary edema, and need for IABP were reduced by >50% (p<0.001; p=0.001; p<0.001, respectively), while myocardial infarction and stroke were not significantly impacted. Conclusions: In this observational cohort study, prophylactc postoperative P-blocker use was associated with shorter hospital LOS by an average of 2.2 days and a 17.3% lower incidence of AF. It may also be associated with reductions in overall mortality, pulmonary edema, and need for an IABP.