title: Perioperative practice: time to throttle back.
abstract: The United States spends more on health care than other nations, yet our health outcomes remain inferior to those of many countries. Change is therefore necessary. One approach to health care reform is to identify and eliminate practices associated with high cost and limited benefit. Recent research has shown that many perioperative practices meet this definition. An opportunity thus exists for rational reduction of perioperative expenditure. Perioperative tests and treatments improve outcomes only when targeted at specific patient subsets. For example, routine perioperative stress testing provides no incremental diagnostic yield in patients at low risk for cardiac events, and indiscriminate perioperative therapy with beta-blockers can increase mortality in otherwise stable patients. Thus, many "accepted" perioperative practices conflict with the evidence and can be safely discontinued while preserving outcomes and reducing costs. Implementation of the American College of Cardiology/American Heart Association perioperative guidelines ensures cost-effective management and promises the greatest benefit for our patients. Our society demands better care at lower cost; in perioperative medicine, it is time for us to throttle back.
authors: University of Michigan Health System, Ann Arbor, Michigan 48109-5853, USA. vineetc@med.umich.edu
authors: Vineet
authors: V
authors: Chopra
authors: Scott A
authors: SA
authors: Flanders
authors: James B
authors: JB
authors: Froehlich
authors: Wei C
authors: WC
authors: Lau
authors: Kim A
authors: KA
authors: Eagle
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000150:complications / Q000628:therapy; D019317:Evidence-Based Medicine; D005080:Exercise Test; D019983:Guideline Adherence; D017048:Health Care Costs; D006801:Humans; D015425:Myocardial Reperfusion; D019990:Perioperative Care / Q000191:economics*; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D014481:United States; D019564:Unnecessary Procedures
chemical_list: D000319:Adrenergic beta-Antagonists