The controversy around perioperative β-blockade (initiation or continuation) has raged for more than 20 years. In 1996, Mangano and colleagues1 reported the results of a randomized clinical trial that showed perioperative β-blockade reduced cardiac mortality for up to 2 years following surgery. This led to an increased rate of β-blocker initiation preoperatively as well as Surgical Care Improvement Project process measures to document adherence to a seemingly life-saving intervention.