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Lack of Physician Concordance With Guidelines on the Perioperative Use of  -Blockers
Anita K. Siddiqui, MD;
Shahid Ahmed, MD;
Henri Delbeau, MD;
David Conner, MD;
Joseph Mattana, MD
Arch Intern Med. 2004;164:664-667.
Background The American College of Physicians recommends perioperative use of  -blockers for certain patients to improve outcomes after surgery. Study of physician behavior with respect to guidelines and recommended practices have shown that -blockers have been underutilized after myocardial infarction. We evaluated physician concordance with the perioperative use of -blockers along with a specialty-related difference in the frequency of perioperative -blocker use.
Methods To determine perioperative use of -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 -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 -blocker use were met in 146 patients (43%) who did not have emergency operations and/or contraindications to -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 -blockers prior to admission, and 102 patients (70%) were not receiving -blockers. Of those 102 patients not receiving -blockers at admission but who meet criteria for their use, 94 (92%) were not started on -blocker therapy preoperatively. Of the 18 patients evaluated by a cardiologist, 4 (22%) were started on -blocker therapy compared with 3 (6%) of 47 patients evaluated by a noncardiologist physician (P = .08).
Conclusion Perioperative -blocker therapy is underutilized in patients with risk factors for coronary artery disease despite evidence that its use in appropriate individuals may be lifesaving.
From the Department of Medicine, Long Island Jewish Medical Center, the Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, NY. The authors have no relevant financial interest in this article.
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