BACKGROUND: The American College of Physicians recommends perioperative use of beta-blockers for certain patients to improve outcomes after surgery. Study of physician behavior with respect to guidelines and recommended practices have shown that beta-blockers have been underutilized after myocardial infarction. We evaluated physician concordance with the perioperative use of beta-blockers along with a specialty-related difference in the frequency of perioperative beta-blocker use. METHODS: To determine perioperative use of beta-blockers, we retrospectively analyzed the medical charts of adult patients who underwent open cholecystectomy at a tertiary care medical center from December 1997 through December 2001. Patients met criteria for perioperative beta-blocker use if they had a history of coronary artery disease or if they had the presence of 2 or more of the following risk factors: 65 years or older; history of hypertension, diabetes mellitus, or hypercholesterolemia; or current smoking. RESULTS: Among the 336 cases of cholecystectomy reviewed, criteria for beta-blocker use were met in 146 patients (43%) who did not have emergency operations and/or contraindications to beta-blocker use. Of these 146 patients, 123 (84%) had a documented preoperative medical evaluation by a physician in the medical chart. There were 44 patients (30%) receiving beta-blockers prior to admission, and 102 patients (70%) were not receiving beta-blockers. Of those 102 patients not receiving beta-blockers at admission but who meet criteria for their use, 94 (92%) were not started on beta-blocker therapy preoperatively. Of the 18 patients evaluated by a cardiologist, 4 (22%) were started on beta-blocker therapy compared with 3 (6%) of 47 patients evaluated by a noncardiologist physician (P =.08). CONCLUSION: Perioperative beta-blocker therapy is underutilized in patients with risk factors for coronary artery disease despite evidence that its use in appropriate individuals may be lifesaving.
BACKGROUND: The American College of Physicians recommends perioperative use of beta-blockers for certain patients to improve outcomes after surgery. Study of physician behavior with respect to guidelines and recommended practices have shown that beta-blockers have been underutilized after myocardial infarction. We evaluated physician concordance with the perioperative use of beta-blockers along with a specialty-related difference in the frequency of perioperative beta-blocker use. METHODS: To determine perioperative use of beta-blockers, we retrospectively analyzed the medical charts of adult patients who underwent open cholecystectomy at a tertiary care medical center from December 1997 through December 2001. Patients met criteria for perioperative beta-blocker use if they had a history of coronary artery disease or if they had the presence of 2 or more of the following risk factors: 65 years or older; history of hypertension, diabetes mellitus, or hypercholesterolemia; or current smoking. RESULTS: Among the 336 cases of cholecystectomy reviewed, criteria for beta-blocker use were met in 146 patients (43%) who did not have emergency operations and/or contraindications to beta-blocker use. Of these 146 patients, 123 (84%) had a documented preoperative medical evaluation by a physician in the medical chart. There were 44 patients (30%) receiving beta-blockers prior to admission, and 102 patients (70%) were not receiving beta-blockers. Of those 102 patients not receiving beta-blockers at admission but who meet criteria for their use, 94 (92%) were not started on beta-blocker therapy preoperatively. Of the 18 patients evaluated by a cardiologist, 4 (22%) were started on beta-blocker therapy compared with 3 (6%) of 47 patients evaluated by a noncardiologist physician (P =.08). CONCLUSION: Perioperative beta-blocker therapy is underutilized in patients with risk factors for coronary artery disease despite evidence that its use in appropriate individuals may be lifesaving.
Authors: Anne Benedicte Juul; Jørn Wetterslev; Christian Gluud; Allan Kofoed-Enevoldsen; Gorm Jensen; Torben Callesen; Peter Nørgaard; Kim Fruergaard; Morten Bestle; Rune Vedelsdal; André Miran; Jon Jacobsen; Jakob Roed; Maj-Britt Mortensen; Lise Jørgensen; Jørgen Jørgensen; Marie-Louise Rovsing; Pernille Lykke Petersen; Frank Pott; Merete Haas; Rikke Albret; Lise Lotte Nielsen; Gun Johansson; Pia Stjernholm; Yvonne Mølgaard; Nikolai Bang Foss; Jeanie Elkjaer; Bjørn Dehlie; Klavs Boysen; Dusanka Zaric; Anne Munksgaard; Jørn Bo Madsen; Bjarne Øberg; Boris Khanykin; Tine Blemmer; Stig Yndgaard; Grazyna Perko; Lars Peter Wang; Per Winkel; Jørgen Hilden; Per Jensen; Nader Salas Journal: BMJ Date: 2006-06-24
Authors: Hiram C Polk; John Birkmeyer; David R Hunt; R Scott Jones; Anthony D Whittemore; Bruce Barraclough Journal: Ann Surg Date: 2006-04 Impact factor: 12.969