Needs analysis for the development of a preoperative clinic protocol for perioperative beta-blocker therapy

Study Objective: To study the development and implementation of a hospital-wide protocol regarding preoperative beta-blocker therapy. Design: Prospective, observational clinical study. Setting: Preoperative test center at a university hospital. Patients: 1,000 consecutive patients presenting for a preoperative visit and scheduled for same-day admit surgery. Interventions: An algorithm of indications and contraindications for beta-blocker therapy was designed. Data were collected prospectively on 1,000 consecutive patients between June 1, 2004 and August 31, 2004. Measurements: Data collected included patient demographics, medication history, risk factors, indications and contraindications to beta-blocker therapy, as well as surgical risk stratification and postoperative complications. Main Results: 960 of the 1,000 patients underwent surgery and had complete information for the study collected. 169 patients (17.6%) were receiving beta blockers prior to evaluation. Of the patients having high-risk surgery, 72% had a major or minor indication for beta-blocker therapy without contraindication. Of the patients having intermediate or low-risk surgery, 10% had a major indication for beta blockers without contraindication. Overall, 52% (409/791) of the patients who were candidates for perioperative beta blockers were not receiving them. Some type of complication was experienced by 59 (6.1%) patients. Conclusions: Development, implementation, and monitoring of perioperative beta-blocker therapy protocols is necessary, as a significant number of appropriate patients do not receive this therapy.