Rebecka Ahl1,2, Peter Matthiessen2,3, Xin Fang4, Yang Cao4,5, Gabriel Sjolin2,3, Rickard Lindgren3, Olle Ljungqvist2,6, Shahin Mohseni2,3. 1. Department of Surgery, Karolinska University Hospital, Stockholm, Sweden. 2. School of Medical Sciences, Orebro University, Orebro, Sweden. 3. Department of Surgery, Orebro University Hospital, Orebro, Sweden. 4. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. 5. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, Orebro, Sweden. 6. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Abstract
OBJECTIVE: To ascertain whether regular β-blocker exposure can improve short- and long-term outcomes after rectal cancer surgery. BACKGROUND: Surgery for rectal cancer is associated with substantial morbidity and mortality. There is increasing evidence to suggest that there is a survival benefit in patients exposed to β-blockers undergoing non-cardiac surgery. Studies investigating the effects on outcomes in patients subjected to surgery for rectal cancer are lacking. METHODS: All adult patients undergoing elective abdominal resection for rectal cancer over a 10-year period were recruited from the prospectively collected Swedish Colorectal Cancer Registry. Patients were subdivided according to preoperative β-blocker exposure status. Outcomes of interest were 30-day complications, 30-day cause-specific mortality, and 1-year all-cause mortality. The association between β-blocker use and outcomes were analyzed using Poisson regression model with robust standard errors for 30-day complications and cause-specific mortality. One-year survival was assessed using Cox proportional hazards regression model. RESULTS: A total of 11,966 patients were included in the current study, of whom 3513 (29.36%) were exposed to regular preoperative β-blockers. A significant decrease in 30-day mortality was detected (incidence rate ratio = 0.06, 95% confidence interval: 0.03-0.13, P < 0.001). Deaths of cardiovascular nature, respiratory origin, sepsis, and multiorgan failure were significantly lower in β-blocker users, as were the incidences in postoperative infection and anastomotic failure. The β-blocker positive group had significantly better survival up to 1 year postoperatively with a risk reduction of 57% (hazard ratio = 0.43, 95% confidence interval: 0.37-0.52, P < 0.001). CONCLUSIONS: Preoperative β-blocker use is strongly associated with improved survival and morbidity after abdominal resection for rectal cancer.
OBJECTIVE: To ascertain whether regular β-blocker exposure can improve short- and long-term outcomes after rectal cancer surgery. BACKGROUND: Surgery for rectal cancer is associated with substantial morbidity and mortality. There is increasing evidence to suggest that there is a survival benefit in patients exposed to β-blockers undergoing non-cardiac surgery. Studies investigating the effects on outcomes in patients subjected to surgery for rectal cancer are lacking. METHODS: All adult patients undergoing elective abdominal resection for rectal cancer over a 10-year period were recruited from the prospectively collected Swedish Colorectal Cancer Registry. Patients were subdivided according to preoperative β-blocker exposure status. Outcomes of interest were 30-day complications, 30-day cause-specific mortality, and 1-year all-cause mortality. The association between β-blocker use and outcomes were analyzed using Poisson regression model with robust standard errors for 30-day complications and cause-specific mortality. One-year survival was assessed using Cox proportional hazards regression model. RESULTS: A total of 11,966 patients were included in the current study, of whom 3513 (29.36%) were exposed to regular preoperative β-blockers. A significant decrease in 30-day mortality was detected (incidence rate ratio = 0.06, 95% confidence interval: 0.03-0.13, P < 0.001). Deaths of cardiovascular nature, respiratory origin, sepsis, and multiorgan failure were significantly lower in β-blocker users, as were the incidences in postoperative infection and anastomotic failure. The β-blocker positive group had significantly better survival up to 1 year postoperatively with a risk reduction of 57% (hazard ratio = 0.43, 95% confidence interval: 0.37-0.52, P < 0.001). CONCLUSIONS: Preoperative β-blocker use is strongly associated with improved survival and morbidity after abdominal resection for rectal cancer.
Authors: Ahmad Mohammad Ismail; Tomas Borg; Gabriel Sjolin; Arvid Pourlotfi; Sebastian Holm; Yang Cao; Per Wretenberg; Rebecka Ahl; Shahin Mohseni Journal: Trauma Surg Acute Care Open Date: 2020-07-29
Authors: Lovisa Ekestubbe; Gary Alan Bass; Maximilian Peter Forssten; Gabriel Sjölin; Yang Cao; Peter Matthiessen; Rebecka Ahl Hulme; Shahin Mohseni Journal: Sci Rep Date: 2022-03-28 Impact factor: 4.379
Authors: Erik Stenberg; Luiz Fernando Dos Reis Falcão; Mary O'Kane; Ronald Liem; Dimitri J Pournaras; Paulina Salminen; Richard D Urman; Anupama Wadhwa; Ulf O Gustafsson; Anders Thorell Journal: World J Surg Date: 2022-01-04 Impact factor: 3.352
Authors: Ahmad Mohammad Ismail; Rebecka Ahl; Maximilian Peter Forssten; Yang Cao; Per Wretenberg; Tomas Borg; Shahin Mohseni Journal: J Trauma Acute Care Surg Date: 2022-01-01 Impact factor: 3.697