The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #73372

Dheeresh K. Mamidi, University of Massachusetts, Amherst, 1040 North Pleasant Street, Apt. # 253, Amherst, MA 01002, 413-459-4581, dmamidi@schoolph.umass.edu

Introduction: Randomized trials have shown that beta-blockers administered to selected patients undergoing major non-cardiac surgery reduce the incidence of cardiac complications and mortality. Little is known about peri-operative beta-blocker (POBB) use in routine clinical practice. Objective: To evaluate the use and impact of POBB among high-risk patients undergoing major non-cardiac surgeries. Methods: Patients 18+ years who underwent major non-cardiac surgery in 2000-2001 at 329 hospitals participating in the Premier-Perspective, a quality and utilization database were included. Using ICD-9-CM codes we computed a Revised Cardiac Risk Index (RCRI) score for each patient, assigning 1 point each for: high-risk surgery, ischemic heart disease, cerebrovascular disease, chronic renal insufficiency, diabetes mellitus. Ideal candidates for POBB use were patients with an RCRI score of 1+ and no contraindications to use. We compared rates of in-hospital mortality among patients receiving POBB vs. not, and evaluated beta-blocker use according to patient and hospital characteristics. Results: Of 782,969 patients undergoing major non-cardiac surgery, 343,415 (44%) appeared to be ideal candidates. Among them 70,793 (21%) were treated with a beta-blocker from the first or second day of admission. Greater use of beta-blockers is seen among patients aged 65+, and for each risk factor. Use varies by hospital size and region of the country. Compared to ideal candidates not treated, those treated prophyllactically had significantly (p<0.001) lower in-hospital mortality across all RCRI strata. Conclusion: There are large opportunities to improve quality of care by increasing the POBB use in routine clinical practice among patients undergoing major non-cardiac surgery.

Learning Objectives:

At the conclusion of the presentation, the participant should be able to identify:
• predictors of perioperative beta-blocker use in routine clinical practice among patients undergoing major non-cardiac surgery.
• effect of perioperative beta-blocker use on in-hospital mortality.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.