title: Improved outcomes associated with a revised quality measure for continuing perioperative β-blockade.
abstract: OBJECTIVE
  The Surgical Care Improvement Project perioperative β-blocker (BB) (SCIP-BB) continuation measure was revised in 2012 to incorporate inpatient BB continuation after discharge from the postanesthesia care unit.
  
  
  OBJECTIVE
  To determine whether adherence to the original or revised SCIP-BB measure is associated with decreased adverse events.
  
  
  METHODS
  Retrospective cohort study using national Veterans Affairs patient-level data on adherence to the original SCIP-BB measure and inpatient BB continuation for operations between July 2006 and August 2009.
  
  
  METHODS
  Data for SCIP-BB measure adherence, inpatient BB continuation, and patient and procedure risk variables were used to estimate the associations between adherence to the original and revised SCIP-BB measures and outcomes of major adverse cardiovascular or cerebrovascular events (MACCEs) and their components of cardiovascular events, cerebrovascular events, and 30-day mortality. In addition to unadjusted estimates, propensity score matching and bootstrapping were used to estimate the associations and generate 95% CIs.
  
  
  METHODS
  Major adverse cardiovascular or cerebrovascular events.
  
  
  RESULTS
  Of 14,420 nonemergent operations with at least 2 postoperative inpatient days, 13,170 (91.3%) adhered to the original SCIP-BB measure, and 480 (3.3%) experienced a MACCE. Propensity score-matched analyses showed that adherence to the original SCIP-BB measure was not associated with MACCEs (odds ratio [OR], 1.00; 95% CI, 0.66-1.54) but was associated with increased cerebrovascular events (OR, 3.01; 95% CI, 1.00-10.07). Adherence to the revised SCIP-BB measure occurred in 11,597 (80.4%), and in matched analysis adherence was associated with decreased MACCEs (OR, 0.75; 95% CI, 0.57-0.95), cardiovascular events (OR, 0.66; 95% CI, 0.46-0.93), and 30-day mortality (OR, 0.74; 95% CI, 0.53-0.98). Adherence to the revised SCIP-BB measure was not associated with increased cerebrovascular events (OR, 1.22; 95% CI, 0.62-2.38).
  
  
  CONCLUSIONS
  Adherence to the original SCIP-BB measure was associated with increased cerebrovascular events but not improved cardiovascular event outcomes. β-Blocker continuation consistent with the revised SCIP-BB measure is associated with reduced MACCEs, cardiovascular events, and 30-day mortality. These data provide a cautionary tale of implementing performance measures before they have been rigorously tested. Although the observed associations between adherence to the revised SCIP-BB measure and outcomes are promising, they should be evaluated in the postimplementation period.
authors.affiliation: Center for Surgical, Medical Acute Care Research and Transitions, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama2Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Richman
authors.affiliation: Department of Surgery, Veterans Affairs Boston Health Care System, Boston University and Harvard Medical School, Boston, Massachusetts.
authors.forename: Kamal M F
authors.initials: KM
authors.lastname: Itani
authors.affiliation: Center for Surgical, Medical Acute Care Research and Transitions, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama2Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham.
authors.forename: Rhiannon J
authors.initials: RJ
authors.lastname: Deierhoi
authors.affiliation: Denver Veterans Affairs Medical Center, Denver, Colorado5University of Colorado Health Outcomes Program and Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora.
authors.forename: William G
authors.initials: WG
authors.lastname: Henderson
authors.affiliation: Center for Surgical, Medical Acute Care Research and Transitions, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama2Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Hawn
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D055118:Medication Adherence; D019990:Perioperative Care; D057216:Propensity Score; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists