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Comment & Response
August 14, 2013

Mortality After Perioperative β-Blocker Use in Noncardiac Surgery

Author Affiliations
  • 1North Texas Veterans Health Care System, Dallas
JAMA. 2013;310(6):645-646. doi:10.1001/jama.2013.8519

To the Editor The large propensity score–matched study by Dr London and colleagues1 concluded that perioperative use of β-blockers was associated with lower 30-day mortality in patients undergoing noncardiac surgery. Two major flaws limit the study’s application as well as the validity of its conclusion.

The first problem is their choice of conditions included in the propensity score matching of patients who were either exposed or not exposed to β-blockers. These conditions included angina within 30 days preoperatively, myocardial infarction 6 months preoperatively, previous coronary intervention procedure, and congestive heart failure 30 days preoperatively (eTable 5 of the article). Because use of β-blockers is strictly indicated in patients who have any of these conditions, the patients who were exposed to β-blockers must be different from those who were not given β-blockers; unexposed patients might have had a contraindication to β-blockers, have been too frail to tolerate them, or were treated at a lower level of care.