Haytham M.A. Kaafarani, MD

A study published by a USF general surgery resident was chosen as one of the Top 10 General Surgery Articles for 2008 by Medscape, a popular international online resource of medical information and education for physicians and other health professionals.

Haytham M.A. Kaafarani, MD, MPH, was lead author of the paper “B-Blockade in Non-Cardiac Surgery: Outcome at All Levels of Risk,” which appeared in the October 2008 issue of the journal Archives of Surgery. The new study found that for some patients undergoing surgery, beta-blockers taken before and around the time of the operation appears to increase the risk of heart attack and death. It received wide national and international attention from the media, including the Boston Globe, CNN, BBC, the Washington Post and Reuters.

Dr. Kaafarani is conducting two years of outcomes research in Boston while earning a master’s degree in health policy and management at Harvard University. He will return to USF to finish the fourth and fifth years of his general surgery residency in July 2010.

The study reported in Archives was conducted by a team led by Dr. Kaafarani and Dr. Kamal M.F. Itani of the Veterans Affairs Boston Health Care System. Guidelines from the American College of Cardiology and the American Heart Association recommend beta-blockers for high-risk patients having surgery, particularly vascular procedures. The authors set out to explore the effect of beta-blockers among patients at all levels of risk for heart problems — high, intermediate and low.

The investigators examined records of patients who underwent non-cardiac surgery, including plastic, vascular, abdominal or hernia repair, at a VA medical center in 2000. Patients receiving beta blockers perioperatively to lower their blood pressure were matched by age, sex, cardiac risk, procedure risk, smoking status and kidney health with patients who underwent surgery at the same time but received no beta blockers.

The researchers found patients at all levels of cardiac risk who received the beta-blockers had lower heart rates before and during the surgery unrelated to their hearts, but in the 30 days following surgery the beta-blocker group had higher rates of heart attacks and death than the control group. No deaths occurred among patients classified as high cardiac risk. However, those in the beta-blocker group who died had significantly higher heart rates before surgery than those who didn’t (86 beats per minute vs.70 beats per minute).

“Our study adds to the controversy regarding the optimal use of perioperative beta-blockers in patient populations at various levels of cardiac risk,” the authors wrote. “Further investigations in this field with standardizing of beta-blockade regimen and with monitoring of heart rate in populations at various levels of cardiac risk should be pursued.”