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Forecasting the Impact of a Clinical Practice Guideline for Perioperative  -Blockers to Reduce Cardiovascular Morbidity and Mortality
Michael Schmidt, BS;
Peter K. Lindenauer, MD, MSc;
Jan L. Fitzgerald, MS, RN;
Evan M. Benjamin, MD
Arch Intern Med. 2002;162:63-69.
Background  -Blockers reduce morbidity and mortality
when administered to high-risk patients undergoing major noncardiac surgery,
yet little is known about how often they are being prescribed. Clinical practice
guidelines are tools that can be used to speed the translation of research
into practice and may be one method to improve the use of -blockers.
Before implementing any guideline, it is important to forecast its potential
clinical and financial impact.
Methods We conducted a retrospective cohort study, using administrative and
medical record review data, of all adult patients undergoing major noncardiac
surgery at Baystate Medical Center, Springfield, Mass, during a 1-month period
in 1999. Patients with 2 or more cardiac risk factors or with documented coronary
artery disease were classified as high risk and were considered eligible for
treatment with a -blocker if they had no obvious contraindications to
its use. We estimated the potential clinical benefit of treating eligible
patients with a -blocker by extrapolating the treatment effect observed
in a previously reported randomized clinical trial.
Results Of 158 patients undergoing major noncardiac surgery, 67 (42.4%) seemed
to be ideal candidates for treatment with perioperative -blockers. Of
these 67 patients, 25 (37%) received a -blocker at some time perioperatively.
During the course of a year, we estimate that between 560 and 801 patients
who do not receive -blockers might benefit from treatment with these
medications. Full use of -blockers among eligible patients at our institution
could result in 62 to 89 fewer deaths each year at an overall cost of $33 661
to $40 210.
Conclusions There seems to be a large opportunity to improve the quality of care
of patients undergoing major noncardiac surgery by increasing the use of -blockers
in the perioperative period. A clinical practice guideline may be one method
to achieve these goals at little cost.
From the Department of Biostatistics and Epidemiology, University of
Massachusetts at Amherst (Mr Schmidt); the Department of Medicine, Tufts University
School of Medicine, Boston (Drs Lindenauer and Benjamin); and the Department
of Medicine (Drs Lindenauer and Benjamin) and the Division of Healthcare Quality
(Drs Lindenauer and Benjamin and Ms Fitzgerald), Baystate Medical Center,
Springfield, Mass.
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