Newswise — A landmark study appearing in the October 2010 issue of Anesthesiology has demonstrated that perioperative beta-blockade - when administered utilizing specific guidelines in at-risk patients - significantly reduced mortality 30 days and one year after surgery. It also found that withdrawal of beta-blockers is associated with increased mortality. With the help of computerized medical records analysis, this extremely cost-effective therapy has been proven to reduce perioperative morbidity in at-risk populations.
According to lead study author Arthur W. Wallace, M.D., Ph.D., the Perioperative Cardiac Risk Reduction Therapy (PCRRT) protocol was developed and implemented to offer protection in patients at risk for adverse cardiac events. This retrospective study offers “real world” evidence about the effectiveness of beta-blocker use in surgical patients.
“This study is unique,” said Dr. Wallace, Professor in Residence in Anesthesiology at UCSF. “There are few studies in the medical literature where a standard of care is adopted and implemented, and in which the safety and efficacy are demonstrated in actual clinical use. There are many things recommended in medicine, but few are really tested.”
The PCRRT protocol was utilized at the San Francisco Veterans Affairs Medical Center from 1996 to 2008 and included analysis of 38,779 surgeries.
This field of medicine has historically had no definitive rules regarding beta-block usage. In a companion editorial to the study, Drs. Pierre Foex and John W. Sear, of the Nuffield Department of Anaesthetics, University of Oxford, U.K., declared that the research performed by Dr. Wallace and his colleagues has reestablished the case for perioperative beta-blockade in noncardiac surgical patients.
“In view of current controversies, this study has the merit of confirming, in a large patient population, that withdrawal of beta-blockade is dangerous. Conversely, maintenance of beta-blockade or its initiation at the time of surgery confers cardiovascular protection,” they said.
Dr. Wallace stressed how important computerized medical records were in the facilitation of his retrospective study, revealing that less than $100,000 was spent throughout the course of two years of analysis – a “trivial” cost compared to alternative techniques, he said.
Dr. Wallace also stated that perioperative beta blockade is delivered at a fraction of the cost of most other approaches to risk reduction, yet remains as or more effective than those other approaches. “How often does a medical therapy cost one ten-thousandth as much and actually work better?” said Dr. Wallace.
The American Society of Anesthesiologists
Anesthesiologists: Physicians providing the lifeline to modern medicine. Founded in 1905, the American Society of Anesthesiologists is an educational, research and scientific association with 45,000 members organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.
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