Evidence map›Paper›PMID 19012955›Full record

SynthesisLancet (London, England)2008

Perioperative beta blockers in patients having non-cardiac surgery: a meta-analysis.

Sripal Bangalore, Jørn Wetterslev, Shruthi Pranesh, Sabrina Sawhney, Christian Gluud, Franz H Messerli

Erratum issuedAbstract readMeta-AnalysisReview
PubMed Publisher
In one paragraph

Synthesis in Lancet (London, England), 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 64 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
64citing papers in PubMed, 11 pooled it
31.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

64 citing papers in PubMed, 11 syntheses or guidelines pooled it, 360 citations in OpenAlex.

  1. Guideline
  2. Beta-blockers in patients without heart failure after myocardial infarction.The Cochrane database of systematic reviews · 2021
    Pooled it
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  5. Beta-blockers for suspected or diagnosed acute myocardial infarction.The Cochrane database of systematic reviews · 2019
    Pooled it
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  12. Trial
  13. Article
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  20. Review

4 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 4 institutions in 2 countries.

Sripal BangaloreDivision of Cardiology, Brigham and Women's Hospital, Boston, MA, USA.
Jørn Wetterslev
Shruthi Pranesh
Sabrina Sawhney
Christian Gluud
Franz H Messerli
St. Luke's-Roosevelt Hospital Center · USBrigham and Women's Hospital · USCopenhagen University Hospital · DKRigshospitalet · DK

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAmerican College of Cardiology and American Heart Association (ACC/AHA) guidelines on perioperative assessment recommend perioperative beta blockers for non-cardiac surgery, although results of some clinical trials seem not to support this recommendation. We aimed to critically review the evidence to assess the use of perioperative beta blockers in patients having non-cardiac surgery.

methodsWe searched Pubmed and Embase for randomised controlled trials investigating the use of beta blockers in non-cardiac surgery. We extracted data for 30-day all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction, non-fatal stroke, heart failure, and myocardial ischaemia, safety outcomes of perioperative bradycardia, hypotension, and bronchospasm.

findings33 trials included 12 306 patients. beta blockers were not associated with any significant reduction in the risk of all-cause mortality, cardiovascular mortality, or heart failure, but were associated with a decrease (odds ratio [OR] 0.65, 95% CI 0.54-0.79) in non-fatal myocardial infarction (number needed to treat [NNT] 63) and decrease (OR 0.36, 0.26-0.50) in myocardial ischaemia (NNT 16) at the expense of an increase (OR 2.01, 1.27-3.68) in non-fatal strokes (number needed to harm [NNH] 293). The beneficial effects were driven mainly by trials with high risk of bias. For the safety outcomes, beta blockers were associated with a high risk of perioperative bradycardia requiring treatment (NNH 22), and perioperative hypotension requiring treatment (NNH 17). We recorded no increased risk of bronchospasm.

interpretationEvidence does not support the use of beta-blocker therapy for the prevention of perioperative clinical outcomes in patients having non-cardiac surgery. The ACC/AHA guidelines committee should soften their advocacy for this intervention until conclusive evidence is available.

Indexed as

Adrenergic beta-AntagonistsCardiovascular DiseasesHemodynamicsHumansIntraoperative CareIntraoperative ComplicationsRandomized Controlled Trials as TopicAdrenergic beta-Antagonists

Identifiers

PMID19012955
OpenAlexW2132907803

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.