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

  • Debra Quinn Kolodner
  • Huong Do
  • Mary Cooper
  • Eliot Lazar
  • Mark Callahan
Original Articles

Abstract

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-antagonists perioperative care quality indicators health care practice guidelines 

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Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  • Debra Quinn Kolodner
    • 1
    • 3
  • Huong Do
    • 2
  • Mary Cooper
    • 3
  • Eliot Lazar
    • 4
  • Mark Callahan
    • 2
    • 3
  1. 1.Division of Outcomes and Effectiveness Research, Department of MedicineColumbia University College of Physicians & Surgeons, Weill Medical College of CornellNew YorkUSA
  2. 2.Division of Outcomes and Effectiveness Research, Department of Public HealthWeill Medical College of CornellNew YorkUSA
  3. 3.New York-Presbyterian HospitalNew YorkUSA
  4. 4.New York-Presbyterian HospitalWeill Medical College of CornellNew YorkUSA

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