Delaying ARBs After Surgery Linked to Greater Mortality

Failure to resume ARBs promptly after surgery linked to increased mortality risk, especially in younger patients.
Failure to resume ARBs promptly after surgery linked to increased mortality risk, especially in younger patients.

(HealthDay News) -- For veterans regularly prescribed angiotensin receptor blockers (ARBs) admitted for noncardiac surgery, failure to resume ARB therapy by postoperative day 2 is associated with increased mortality risk, according to a study published online in Anesthesiology.

Susan M. Lee, M.D., from the University of California in San Francisco, and colleagues conducted a retrospective cohort study to examine patterns of postoperative ARB use in veterans regularly prescribed ARBs who were admitted for noncardiac surgery between 1999 and 2011. The authors assessed the effect of failure to resume ARBs by postoperative day 2 on all-cause 30-day mortality. Data were included for 30,173 inpatient surgical admissions.

The researchers found that approximately 33.8% of patients did not resume ARBs by postoperative day 2. The 30-day mortality rate was 1.3% for those who resumed ARBs, compared with 3.2% for those who had ARBs withheld (multivariable adjusted hazard ratio, 1.74; P < 0.001). In a propensity score-matched subset of 19,490 patients, the hazard ratio was similar (hazard ratio, 1.47; P < 0.001). The mortality risk was increased in younger patients who did not resume ARBs (hazard ratio, 2.52; P < 0.001 for those younger than 60 years) compared with older patients (hazard ratio, 1.42; P < 0.01 for patients aged older than 75 years).

"Withholding ARBs is strongly associated with increased 30-day mortality, especially in younger patients, although residual confounding may be present," the authors write.

Source

  1. Lee, SM, et al. Anesthesiology, published May 2015; doi: 10.1097/ALN.0000000000000739.
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