Effects of Perioperative Beta-Blockers on Postoperative Major Adverse Cardiovascular and Cerebrovascular Events in Patients with Colorectal Cancer : a propensity score matching analysis

Abstract Background Patients with colorectal cancer (CRC) undergoing surgical resection face a high risk of perioperative adverse events, and the relationship between perioperative use of beta-blockers and major adverse cardiovascular and cerebrovascular events (MACCE) after surgery remains unelucidated. Methods Consecutive patients newly received radical surgery for CRC between 1 September 2019 and 30 September 2021 were identified through the research database and electronic medical records of the Union Hospital of Fujian Medical University. Patients were categorized into two groups based on the use of perioperative beta-blockers, and a 1:2 propensity-score matching (PSM) analysis was conducted to balance confounding factors. The primary outcome was the incidence of MACCE within 30 days postoperatively. Results A total of 1859 patients with complete medical records were included in the study. Among these, 80 patients developed MACCE, resulting in an overall incidence rate of 4.3%. Prior to PSM, the MACCE incidence was significantly higher in the beta-blockers group compared to the non-beta-blockers group (12.7% vs. 3.8%, OR 3.72, 95% CI 2.02 to 6.86, P < 0.001). After 1:2 PSM, MACCE incidence which 108 patients in the beta-blockers group and 216 patients in the non-beta-blockers group were included, remained higher in the beta-blockers group (13.0% vs. 4.6%, OR 3.07,95% CI 1.32 to 7.16, P = 0.007). There was no significant difference in total morbidity between the groups (38.9% vs.44.4%, OR 1.26, 95% CI 0.79 to 2.01, P = 0.34). Sensitivity analyses further supported these findings. Conclusions Perioperative use of beta-blockers in patients with CRC is independently associated with an increased risk of postoperative MACCE; however, this association may not be purely causal but rather reflects the generally poorer overall health status and higher invasiveness of surgery in the group of patients receiving these medications.