Predictors of perioperative beta-blockade use in vascular surgery: a mail survey of United States anesthesiologists.
OBJECTIVE
It was hypothesized that anesthesiologists' decisions to provide perioperative beta-blockade during vascular surgery would be influenced more by physician factors than by those of their patients.


METHODS
Mail survey.


METHODS
Case presentation.


METHODS
Four hundred thirty-nine anesthesiologists in the United States who responded to a survey.


METHODS
By using Microsoft Word Mail Merge (Microsoft, Redmond, WA), 6 factors in a hypothetical patient presenting for vascular surgery (sex, race, age, comorbidities, functional status, and magnitude of surgical stress) were randomly varied.


RESULTS
The response rate was 22%. Self-reported propensity to use beta-blockade was significantly increased among anesthesiologists who worked in New England, among those who worked in larger hospitals, or who had received fellowship training. Among healthy patients, beta-blockers were more likely to be used for older than younger patients. Among sicker patients, however, the reverse was true. Heart rate triggers for beta-blockade use were higher than heart rates associated with improved outcomes in pivotal beta-blocker trials.


CONCLUSIONS
Preferences for perioperative beta-blockade use in vascular surgery patients are influenced by anesthesiologists' demographics as well as patient comorbidities or degree of surgical stress. This finding suggests that efforts to increase perioperative beta-blockade in high-risk vascular patients face significant barriers from some groups of clinicians.
Ellis
John E
JE
Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL 60637, USA. johnellis1700@gmail.com
Tung
Avery
A
Lee
Hubert
H
Kasza
Kristen
K
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000776:Anesthesiology; D003625:Data Collection; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy; D019990:Perioperative Care; D011177:Postal Service; D014656:Vascular Surgical Procedures
D000319:Adrenergic beta-Antagonists