Predictors of Perioperative β-Blockade Use in Vascular Surgery: A Mail Survey of United States Anesthesiologists

Abstract

It was hypothesized that anesthesiologists' decisions to provide perioperative beta-blockade during vascular surgery would be influenced more by physician factors than by those of their patients. Mail survey. Case presentation. Four hundred thirty-nine anesthesiologists in the United States who responded to a survey. By using Microsoft Word Mail Merge (Microsoft, Redmond, WA), 6 factors in a hypothetical patient presenting for vascular surgery (sex, race, age, comorbidities, functional status, and magnitude of surgical stress) were randomly varied. The response rate was 22%. Self-reported propensity to use beta-blockade was significantly increased among anesthesiologists who worked in New England, among those who worked in larger hospitals, or who had received fellowship training. Among healthy patients, beta-blockers were more likely to be used for older than younger patients. Among sicker patients, however, the reverse was true. Heart rate triggers for beta-blockade use were higher than heart rates associated with improved outcomes in pivotal beta-blocker trials. Preferences for perioperative beta-blockade use in vascular surgery patients are influenced by anesthesiologists' demographics as well as patient comorbidities or degree of surgical stress. This finding suggests that efforts to increase perioperative beta-blockade in high-risk vascular patients face significant barriers from some groups of clinicians.