Sex-Related Differences in Outcome After High-Risk Vascular Surgery After the Administration of β-Adrenergic–Blocking Drugs

Matyal, Robina; Mahmood, Feroze; Panzica, Peter; Pomposelli, Frank; Park, Kyung W.; Hamden, Allen; Schermerhorn, Mark; Hess, Philip

doi:10.1053/j.jvca.2007.12.021

« Previous Next »Journal of Cardiothoracic and Vascular Anesthesia
Volume 22, Issue 3 , Pages 354-360, June 2008

Sex-Related Differences in Outcome After High-Risk Vascular Surgery After the Administration of β-Adrenergic–Blocking Drugs

Robina Matyal, MD
- Department of Anesthesia and Critical Care and Pain Management, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Address reprint requests to Robina Matyal, MD, Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, CC-470, Deaconess 1, Boston, MA 02215.
Feroze Mahmood, MD
- Department of Anesthesia and Critical Care and Pain Management, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Peter Panzica, MD
- Department of Anesthesia and Critical Care and Pain Management, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Frank Pomposelli, MD
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Kyung W. Park, MD
- Department of Anesthesia and Critical Care and Pain Management, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Allen Hamden, MD
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Mark Schermerhorn, MD
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Philip Hess, MD
- Department of Anesthesia and Critical Care and Pain Management, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

published online 25 March 2008.

Background: β-Adrenergic–blocking medications may have a cardioprotective effect after high-risk vascular surgery. This effect has been shown primarily in men and has not been independently shown in women.

Methods: Retrospective data were collected from vascular surgery (primarily infrainguinal) patients. Adverse outcome was defined as myocardial infarction, new-onset congestive heart failure (CHF), significant arrhythmia, renal failure, or death. The incidence of adverse outcomes was compared independently for both men and women based on the administration of perioperative β-blockade. Analysis was performed for the whole population and for the subset of patients who were not on preoperative β-blockers (β-blocker naïve). Risk-stratified analysis was used to determine which group received any effect from β-blockade. Logistic regression was performed to determine the independent effect of perioperative β-blockade in both sexes.

Results: There were 594 men and 366 women. The incidence of adverse outcomes was lower when β-blockers were administered in men (12.6% v 18.9%, p = 0.04) but not in women (17.8% v 13.7%, p = 0.37). Among β-blocker–naïve subjects, men had significant reductions in myocardial infarction and renal failure, whereas women did not have a reduction in the incidence of any outcome. After risk-stratification, the high-risk women who received β-blockade had a statistically worse outcome (36.8% v 5.9%, p = 0.02) because of an increased incidence of CHF. By logistic regression, β-blockade improved outcomes in men but not women.

Conclusion: In this retrospective analysis, women did not benefit from perioperative β-blockade. Women at high risk appeared to have a worse outcome because of a higher incidence of CHF.

Key words: β-adrenergic–blocking drugs, sex, vascular surgery, outcome