Release Notes:
Measure Information Form
Version 2010A1
**NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE**Measure Information Form
Measure Set: Surgical Care Improvement Project (SCIP)
Set Measure ID: SCIP-Card-2
Performance Measure Name: Surgery Patients on Beta-Blocker Therapy Prior to Admission Who Received a Beta-Blocker During the Perioperative Period
Description: Surgery patients on beta-blocker therapy prior to admission who received a beta-blocker during the perioperative period. The perioperative period for the SCIP Cardiac measures is defined as 24 hours prior to surgical incision through discharge from post-anesthesia care/recovery area.
Rationale: Concerns regarding the discontinuation of beta-blocker therapy in the perioperative period have existed for several decades. Shammash and colleagues studied a total of 140 patients who received beta-blockers preoperatively. Mortality in the 8 patients who had beta-blockers discontinued postoperatively (50%) was significantly greater than in the 132 patients in whom beta-blockers were continued. Hoeks and colleagues studied 711 consecutive peripheral vascular surgery patients. After adjustment for potential confounders and the propensity of its use, continuous beta-blocker use remained significantly associated with a lower 1-year mortality than among nonusers. In contrast, beta-blocker withdrawal was associated with an increased risk of 1-year mortality compared with nonusers. The American College of Cardiology/American Heart Association site continuation of beta-blocker therapy in the perioperative period as a class I indication, and accumulating evidence suggests that titration to maintain tight heart rate control should be the goal.
Type of Measure: Process
Improvement Noted As: Increase in the rate
Numerator Statement: Surgery patients on beta-blocker therapy prior to admission who receive a beta-blocker during the perioperative period.
Included Populations: Not applicable
Excluded Populations: None
Data Elements:
Denominator Statement: All surgery patients on beta-blocker therapy prior to admission
Included Populations:
ICD-9-CM Principal Procedure Code of selected surgeries (as defined in Appendix A, Table 5.10 for ICD-9-CM codes).
Excluded Populations:
- Patients less than 18 years of age
- Patients who have a length of Stay >120 days
- Patients whose ICD-9-CM principal procedure was performed entirely by laparoscope
- Patients enrolled in clinical trials
- Patients whose ICD-9-CM principal procedure occurred prior to the date of admission
- Patients who expired during the perioperative period
- Pregnant patients taking a beta-blocker prior to admission
- Patients who did not receive beta-blockers due to contraindications as documented in the medical record
Data Elements:
Continuous Variable Statement:
Included Populations:
Excluded Populations:
Data Elements:
Risk Adjustment: No.
Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. Retrospective data sources for required data elements include administrative data and medical records.
Data Accuracy: Variation may exist in the assignment of ICD-9-CM codes; therefore, coding practices may require evaluation to ensure consistency.
Measure Analysis Suggestions: This measure seeks to identify surgery patients who were on beta-blocker therapy prior to admission that received a perioperative beta-blocker. Health care organizations can identify patients who were on beta-blocker therapy for an extended period of time and compare them to those who received beta-blockers perioperatively, or those who did not receive the medication due to other reasons, i.e., complications or early discharges. An additional step would be to correlate the post hospital stay period to the beta-blocker administration during the pre/perioperative period. This will allow health care organization to take appropriate steps to ensure that patients receive the necessary care to reduce the risk of cardiovascular complications in the postoperative period.
Sampling: Yes. For additional information see the Sampling Section.
Data Reported As: Aggregate rate generated from count data reported as a proportion.
Selected References:
- Manual of Medical Therapeutics. Department of Medicine Washington University, School of Medicine, St. Louis, MO, GA Ewald and CR McKenzie editors. 28th Edition, 1995. PMID: 0000000.
- Belzberg H, Rivkind AI. Preoperative cardiac preparation. Chest. 1999;115:82S-95S. PMID: 10331339.
- Poldermans D, Boersma E, Bax JJ, et al, for the DECREASE Study Group. The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. N Engl J Med. 1999;24:1789-1794. PMID: 10588963.
- Shammash JB, Trost JC, Gold JM, et al. Perioperative beta-blocker withdrawal and mortality in vascular surgical patients. Am Heart J. 2001;141:148-153. PMID: 11136500.
- Boersma E, Poldermans D, Bax JJ, et al, for the Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography (DECREASE) Study Group. Predictors of cardiac events after major vascular surgery: role of clinical characteristics, dobutamine echocardiography. PMID:11308400.
- Pasternack PF, Imparato AM, Baumann FG, et al. The hemodynamics of beta-blockade in patients undergoing abdominal aortic aneurysm repair. Circulation. 1987;76(suppl 3, pt 2):III-1-7. PMID:3621532.
- Yaeger RA, Moneta GL, Edwards JM, et al. Reducing perioperative myocardial infarction following vascular surgery. The potential role of beta-blockade. Archives of Surgery 1995;130(8):869. http://archsurg.ama-assn.org/cgi/content/abstract/130/8/869. (Last accessed 01/02/05) PMID:7632148.
- Yusuf S, Peto R, Lewis J, Collins R, et al. Beta Blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis 1985; 27: 335-371. PMID: 2858114.
- McGory ML, Maggard MA, Ko CY. A meta-analysis of perioperative beta blockade: What is the actual risk reduction? Surgery. 2005 Aug;138(2):171-179. PMID: 16153424.
- Fleisher LA, Beckman JA, Brown KA, Calkins H, et al. ACC/AHA 2006 Guideline update on perioperative cardiovascular evaluation for noncardiac surgery: Focused update on perioperative beta-blocker therapy. Am Coll J Cardiol, Vol 47. http://www.acc.org/clinical/guidelines/perio/periobetablocker.pdf (Last accessed 04.03.06).
- Goldman L. Noncardiac surgery in patients receiving propranolol. Case reports and recommended approach. Arch Intern Med 1981;141:193-6.
- Hoeks SE, Scholte Op Reimer WJ, van Urk H, et al. Increase of 1-year mortality after perioperative beta-blocker withdrawal in endovascular and vascular surgery patients. Eur J Vasc Endovasc Surg 2007;33:139.
Measure Algorithm:
Attach file