IARS: Beta Blockers Lower Risk, Save Money in Surgeries

SAN DIEGO, CA — March 21, 2002 — Beta blockers cut the risk of cardiac complications in noncardiac surgeries, and save money as well, suggests a cost analysis study reported here on March 18th at the 76th Clinical and Scientific Congress of the International Anesthesia Research Society.

Dr. Lee Fleisher of the Johns Hopkins University Medical Institutions in Baltimore, Maryland, described a chart review of 596 patients, with Medicare data extracted on costs of surgeries, complications and death, following a resection of an aortic aneurysm.

Five strategies for applying beta blockers in a protective manner before or during surgery were constructed and analyzed for cost. Patients were grouped into those who died in hospital, who had codes associated with acute myocardial infarction, or whose course after surgery was uncomplicated.

Beta blockade could be administered by either of the following four strategies: 1) bisoprolol a week before surgery; 2) atenolol just before surgery; 3) esmolol during surgery, with conversion to intravenous, then oral atenolol; 4) esmolol during surgery, and 18 hours after surgery, with conversion to atenolol. These strategies have been put forth as reasonable to establish a protective beta blockade. The options take into account that some patients may not be able to be given the protection prior to their surgery.

Cost of these drug therapy options was calculated from wholesale prices. Surgery costs were obtained by a 5 percent sample of Medicare data from 1998 to 1999 for aortic aneurysm resection.

Perioperative mortality of 3.9 percent incurred a cost of $50,027 per patient. Uncomplicated courses cost $28,118 per patient. Acute MI cost $43,225 per patient (10 percent of patients were estimated to have had acute myocardial infarction).

The strategy of seven days titration with beta blockade showed the best cost savings — $509 per patient. The other strategies showed savings ranging from $337 to $382.

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