Journal of General Internal Medicine

, 21:596

Lack of adherence with preoperative B-blocker recommendations in a multicenter study


    • Division of Outcomes and Effectiveness Research, Department of MedicineColumbia University College of Physicians & Surgeons, Weill Medical College of Cornell
    • New York-Presbyterian Hospital
  • Huong Do
    • Division of Outcomes and Effectiveness Research, Department of Public HealthWeill Medical College of Cornell
  • Mary Cooper
    • New York-Presbyterian Hospital
  • Eliot Lazar
    • New York-Presbyterian HospitalWeill Medical College of Cornell
  • Mark Callahan
    • Division of Outcomes and Effectiveness Research, Department of Public HealthWeill Medical College of Cornell
    • New York-Presbyterian Hospital
Original Articles

DOI: 10.1111/j.1525-1497.2006.00408.x

Cite this article as:
Kolodner, D.Q., Do, H., Cooper, M. et al. J Gen Intern Med (2006) 21: 596. doi:10.1111/j.1525-1497.2006.00408.x


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.

DESIGN: 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.

PARTICIPANTS: The study sample included 1,304 randomly selected patients meeting the guideline criteria for preoperative B-blockade.

MEASUREMENTS AND MAIN 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.

Key words

adrenergic β-antagonistsperioperative carequality indicatorshealth carepractice guidelines

Copyright information

© Society of General Internal Medicine 2006