J Clin Outcomes Manage
An operative risk management pathway to increase perioperative beta-blocker utilization in patients undergoing elective total hip or knee arthroplasty
Robinson RL, Antonini JM, Hasan S, Bussing R, Vautrain R
Abstract Objective: To assess the impact of an operative risk management pathway that promotes the use of perioperative b blockers. Methods: A before and after intervention cohort study was conducted at a tertiary care referral center. Results: Data from 300 consecutive preintervention and 300 consecutive postintervention total hip and knee arthroplasty patients were gathered. Perioperative b-blocker use increased from 18% to 60% (p < 0.001), with a corresponding reduction in cardiovascular complications (11% versus 1.1%; p < 0.001). The rates of cardiac ischemia (7% versus 1%; p < 0.001), myocardial infarction (3% versus 1%; p = 0.038), angina (4% versus 1%; p = 0.002), congestive heart failure (4% versus 0%; p < 0.001), and hospital length of stay (3.55 days versus 3.9 days; p = 0.005) were reduced in the postintervention group. Conclusion: An operative risk management pathway promoting the use of perioperative b blockers was effective for increasing appropriate utilization of perioperative b blockers and reduced the overall rate of perioperative cardiovascular complications for elective hip or knee arthroplasty.
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