title: Lack of adherence with preoperative B-blocker recommendations in a multicenter study.
abstract: BACKGROUND
  Clinical guidelines support the use of preoperative B-blocker in select patients. Patient safety groups have sought to measure the level of adherence to these recommendations.
  
  
  OBJECTIVE
  This study was performed to compare the utilization of preoperative B-blocker with current guidelines across multiple diverse institutions.
  
  
  METHODS
  Retrospective chart review was performed of inpatients undergoing noncardiac surgery across 5 hospital centers during 2003 to 2004. The primary outcome of interest was the administration of preoperative B-blocker.
  
  
  METHODS
  The study sample included 1,304 randomly selected patients meeting the guideline criteria for preoperative B-blockade.
  
  
  RESULTS
  Among patients meeting recommendations for preoperative B-blocker, only 44% (430/983) received B-blocker before surgery. Patients who had not previously received B-blocker were given B-blocker before surgery in only 14% (85/600) of cases. Target heart rates goals for perioperative B-blockade were achieved in 26% (113/430) of cases. Predictors for initiating preoperative B-blocker included nonelective surgery or a history of hypertension or diabetes. Individual hospitals were independently predictive of preoperative B-blocker administration in multivariable models.
  
  
  CONCLUSIONS
  Preoperative B-blocker was significantly underutilized when compared with the current guideline recommendations. Target heart rate goals were not achieved in clinical practice, and few hospitalized patients had preoperative B-blockade initiated. The lack of adherence to preoperative B-blocker recommendations in practice may be impacted by ongoing clinical questions regarding the appropriate selection of candidates for this therapy. Further efforts toward achieving guideline recommendations for preoperative B-blocker use should be focused on the subset of patients that are uniformly agreed upon to be at high risk for cardiac events.
authors.affiliation: Division of Outcomes and Effectiveness Research, Department of Medicine, Columbia University College of Physicians & Surgeons, Weill Medical College of Cornell, New York, NY, USA. daq1@columbia.edu
authors.forename: Debra Quinn
authors.initials: DQ
authors.lastname: Kolodner
authors.forename: Huong
authors.initials: H
authors.lastname: Do
authors.forename: Mary
authors.initials: M
authors.lastname: Cooper
authors.forename: Eliot
authors.initials: E
authors.lastname: Lazar
authors.forename: Mark
authors.initials: M
authors.lastname: Callahan
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D010349:Patient Compliance; D011300:Preoperative Care; D012189:Retrospective Studies; D012984:Software; D016312:Treatment Refusal
chemical_list: D000319:Adrenergic beta-Antagonists