Beta-Blockers in AAA Repair Reduce Deaths 51 Percent
June 2, 2008 - Beta-blocker usage for elective abdominal aortic aneurysm (AAA) repair reduced in-hospital mortality by 51 percent compared to control hospitals over the same time period, according to findings published in the 2008 issue of the Journal of Vascular Surgery.
The findings also emphasize the importance of adhering to standards set by the Leapfrog Group, a consortium of business and healthcare leaders, which critically studies specific medical therapies and health care practices, and assesses their impact on improving outcomes. The Leapfrog Group advocates that patients undergoing AAA repair be referred to hospitals that perform at least 50 or more annual elective AAA repair procedures, including cases done using open and endovascular AAA (EVAR) techniques. It also recommends that a beta-blocker medication be routinely prescribed during the perioperative period to patients undergoing this high-risk operation.
Researchers from Johns Hopkins University School of Medicine in Baltimore compared trends in the in-hospital death rate and outcomes among patients having elective open and endovascular AAA repair in California hospitals that met or did not meet Leapfrog standards. Hospital characteristics, in-hospital mortality and hospital length of stay were studied during the first six years of this patient safety initiative.
Benjamin S. Brooke, M.D., department of surgery, Johns Hopkins Hospital said, "Among 140 hospitals in California that performed open AAA repair, 25 met the Leapfrog case-volume standard; 32 were compliant with routine perioperative beta-blocker use; five hospitals met both criteria; and 78 control hospitals failed to meet either standard."
Hospitals that implemented a policy for beta-blocker usage were found to have an estimated 51 percent reduction of in-hospital mortality following open AAA repair, compared to control hospitals over the same time period.
Among 111 California hospitals where EVAR procedures were performed, there was an estimated 61 percent reduction of in-hospital mortality over time among hospitals meeting case volume standards when compared to control hospitals, although these results did not reach statistical significance. There was no reduction in length of hospital stay over time following either EVAR or open AAA repair for hospitals meeting Leapfrog standards, as compared to control hospitals.
Dr. Brooke noted that this study was the first to conclusively demonstrate that hospitals meeting Leapfrog standards for AAA repair achieve improved mortality outcomes, although it appears that their effects over time are influenced by the type of repair procedure undertaken.
"It is becoming increasingly clear that dramatic improvements in outcomes can be achieved by both large and small hospitals that implement evidence-based process measures such as routine beta-blocker use," added Dr. Brooke. "Our findings strongly support the Leapfrog Group's efforts aimed at directing patient referral to hospitals that comply with standards associated with improving patient outcomes and saving lives."
He added that further studies and large-scale quality improvement research projects should be expanded to help promote the standardization of other evidence-based measures that may improve vascular surgery outcomes.
For more information: www.vascularweb.org