• Debra Quinn Kolodner, Huong Do, Mary Cooper, Eliot Lazar, and Mark Callahan.
• Division of Outcomes and Effectiveness Research, Department of Medicine, Columbia University College of Physicians & Surgeons, Weill Medical College of Cornell, New York, NY, USA. daq1@columbia.edu
• J Gen Intern Med. 2006 Jun 1; 21 (6): 596601596-601.

BackgroundClinical 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.ObjectiveThis study was performed to compare the utilization of preoperative B-blocker with current guidelines across multiple diverse institutions.DesignRetrospective 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.ParticipantsThe study sample included 1,304 randomly selected patients meeting the guideline criteria for preoperative B-blockade.Measurements And Main ResultsAmong 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.ConclusionsPreoperative 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.

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