Preoperative beta blocker use and postoperative ischaemic stroke risk in noncardiac surgery: a multicentre retrospective cohort study
Issued Date
2026-01-01
Resource Type
ISSN
00070912
eISSN
14716771
Scopus ID
2-s2.0-105041709174
Pubmed ID
41506973
Journal Title
British Journal of Anaesthesia
Rights Holder(s)
SCOPUS
Bibliographic Citation
British Journal of Anaesthesia (2026)
Suggested Citation
Rudolph M.I., Borngaesser F., Zmily O.M., Mpody C., Wongtangman K., Wachtendorf L.J., Khandaker R., Suleiman A., Binda D.D., Ramishvili T., Schaefer M.S., Di Biase L., Garcia M.J., Nafiu O.O., Devereaux P.J., Bhatt D.L., Eikermann M., Karaye I.M. Preoperative beta blocker use and postoperative ischaemic stroke risk in noncardiac surgery: a multicentre retrospective cohort study. British Journal of Anaesthesia (2026). doi:10.1016/j.bja.2025.11.027 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/117425
Title
Preoperative beta blocker use and postoperative ischaemic stroke risk in noncardiac surgery: a multicentre retrospective cohort study
Author's Affiliation
Harvard Medical School
Icahn School of Medicine at Mount Sinai
Albert Einstein College of Medicine
Heinrich-Heine-Universität Düsseldorf
Universitätsklinikum Essen
Universität Oldenburg
Boston Medical Center
Siriraj Hospital
McMaster University, Faculty of Health Sciences
Hofstra University
Medizinische Fakultät
School of Medicine
Icahn School of Medicine at Mount Sinai
Albert Einstein College of Medicine
Heinrich-Heine-Universität Düsseldorf
Universitätsklinikum Essen
Universität Oldenburg
Boston Medical Center
Siriraj Hospital
McMaster University, Faculty of Health Sciences
Hofstra University
Medizinische Fakultät
School of Medicine
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: A previous large clinical trial demonstrated an increased risk of perioperative stroke with beta blockers initiated just before surgery. This study evaluated the association between long-term beta blocker prescription and ischaemic stroke after noncardiac surgery. Methods: We conducted a multicentre retrospective study of male and female adults undergoing noncardiac surgery between 2005 and 2021 at two academic healthcare networks in the USA. The primary exposure was long-term beta blocker prescription within 1 yr before surgery. We assessed postoperative ischaemic stroke risk at 30 and 365 days using modified Poisson regression with robust error variances, and conducted effect modification analyses. Results: Long-term beta blocker prescription was associated with an increased risk of postoperative stroke at 30 days (adjusted relative risk [RRadj] 1.26, 95% confidence interval [CI] 1.17–1.36, P<0.001) and 365 days (RRadj 1.22, 95% CI 1.16–1.28, P<0.001). For stroke within 365 days of surgery, this association was amplified in patients with ASA physical status of 1–2 (RRadj 1.96, 95% CI 1.56–2.45, P<0.001) compared with that in patients with ASA physical status of 3–4 (RRadj 1.20, 95% CI 1.15–1.26, P<0.001; P for interaction <0.001). No significant association was observed in patients with severe heart failure. Conclusions: Long-term beta blocker prescription was associated with increased risk of ischaemic stroke within 30 days and up to 365 days after surgery. No association of beta blocker use and ischaemic stroke risk was observed in patients with severe heart failure, or a history of stroke.