Greater use of perioperative beta-blockers urged for noncardiac surgery patients

NEW YORK (Reuters Health) – To reduce the risk of postoperative cardiac complications, more high-risk patients undergoing major noncardiac surgery should receive beta-blocker therapy, researchers report.

"There may be an opportunity to improve the care of patients undergoing major noncardiac surgery by increasing the perioperative use of beta-blockers, especially amongst patients at higher risk for developing cardiac complications," Dr. Peter K. Lindenauer, from Baystate Medical Center, Springfield, Massachusetts, told Reuters Health.

Dr. Lindenauer and colleagues retrospectively analyzed data on 158 patients undergoing major noncardiac surgery at Baystate Medical Center during 1 month in 1999. The researchers classified patients with two or more coronary risk factors or with a history of coronary artery disease as high-risk patients, according their report in the Archives of Internal Medicine for January 14.

Among the 158 patients studied, 67 met the criteria for perioperative beta-blocker treatment. Only 25 of these patients had received beta-blockers at some time before surgery, the researchers found.

Dr. Lindenauer's team estimated that during the course of 1 year, between 560 and 801 patients who did not receive perioperative beta-blocker therapy might have benefited from it. By extrapolating the treatment effect reported in previous clinical trials, they further calculated that if high-risk patients were given perioperative beta-blocker treatment there would be 62 to 89 fewer deaths in that period.

"If practice at our hospital reflects care occurring at similar institutions, then there is a sizable opportunity to improve the care of patients undergoing major noncardiac surgery nationwide," the investigators note.

Dr. Lindenauer and colleagues suggest that "based on this analysis, the use of a clinical practice guideline or other measures intended to improve the use of perioperative beta-blockers in high-risk patients should be strongly considered."

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