Lack of adherence with preoperative B-blocker recommendations in a multicenter study.
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.
Kolodner
Debra Quinn
DQ
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
Do
Huong
H
Cooper
Mary
M
Lazar
Eliot
E
Callahan
Mark
M
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
D000319:Adrenergic beta-Antagonists