By increasing the use of beta-blockers in the perioperative period for high-risk patients undergoing major noncardiac surgery, a clinical practice guideline seems to have improved the quality of care at little cost.

The researchers in this retrospective cohort study, used administrative and abstracted medical record data of adult patients undergoing major noncardiac surgery at Baystate Medical Center, Springfield, Mass, during a 1-month period in 1999. Patients with 2 or more cardiac risk factors or with documented coronary artery disease were classified as high risk and were considered eligible for treatment with a beta-blocker if they had no obvious contraindications. They estimated the potential clinical benefit of treating eligible patients with a beta-blocker by extrapolating the treatment effect observed in a previously reported randomized clinical trial.

Results "Of 158 patients undergoing major noncardiac surgery, 67 (42.4%) seemed to be ideal candidates for treatment with perioperative beta-blockers. Of these 67 patients, 25 (37%) received a beta-blocker at some time perioperatively. During the course of a year, [they] estimate[d] that between 560 and 801 patients who do not receive beta-blockers might benefit from treatment with these medications. Full use of beta-blockers among eligible patients at [their] institution could result in 62 to 89 fewer deaths each year at an overall cost of $33 661 to $40 210."

Schmidt M, Lindenauer PK Fitzgerald JL, Benjamin EM. Forecasting the Impact of a Clinical Practice Guideline for Perioperative beta-Blockers to Reduce Cardiovascular Morbidity and Mortality. Arch Intern Med. 2002;162:63-69.