Effect of β-blocker Prescription on the Incidence of Postoperative Myocardial Infarction after Hip and Knee Arthroplasty
Bibliographic record
Abstract
BACKGROUND: American College of Cardiology/American Heart Association guidelines recommend beta-blockade for selected low- and intermediate-risk noncardiac surgery patients. The authors evaluated the effect of perioperative beta-blockade on postoperative myocardial infarction (POMI) in low-risk patients undergoing intermediate-risk surgery. METHODS: Patients who underwent elective hip or knee arthroplasty between January 1, 2002 and June 30, 2006 were identified. POMI was defined as a Troponin T value of more than 0.1 ng . ml(-1). Patients were divided into three groups: those prescribed a beta-blocker on the day of surgery and throughout their hospital stay (or 7 days, whichever came first), those prescribed a beta-blocker on the day of surgery but discontinued during the first 7 days, and those not prescribed a beta-blocker on the day of surgery. Propensity analysis and logistic regression were used to determine the independent association of beta-blocker exposure on POMI. RESULTS: Of the 5,158 arthroplasty patients, 992 (18%) were treated with beta-blockers on the day of surgery. This beta-blocker was discontinued in 252 patients (25%). POMI occurred in 77 patients (1.5%). Discontinuation of beta-blocker prescription was significantly associated with POMI (odds ratio 2.0; 95% CI 1.1-3.9) and death (odds ratio 2.0; 95% CI 1.0-3.9). CONCLUSION: After adjustment for confounders, discontinuation of beta-blocker prescription during the first week after surgery was significantly associated with POMI and death. These findings confirm the American College of Cardiology/American Heart Association Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery, which recommend not to withdraw beta-blocker therapy.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".