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

Objectives: It was hypothesized that anesthesiologists’ decisions to provide perioperative β-blockade during vascular surgery would be influenced more by physician factors than by those of their patients.Design: Mail survey.Setting: Case presentation.Participants: Four hundred thirty-nine anesthesiologists in the United States who responded to a survey.Interventions: 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.Measurements and Main Results: The response rate was 22%. Self-reported propensity to use β-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, β-blockers were more likely to be used for older than younger patients. Among sicker patients, however, the reverse was true. Heart rate triggers for β-blockade use were higher than heart rates associated with improved outcomes in pivotal β-blocker trials.Conclusions: Preferences for perioperative β-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 β-blockade in high-risk vascular patients face significant barriers from some groups of clinicians.