Perioperative Practice: Time to Throttle Back?

From the Annals of Internal Medicine:

The United States spends more on health care than other nations, yet our health outcomes remain inferior to those of many countries.

Many "accepted" perioperative practices conflict with the evidence, for example:

- Routine perioperative stress testing provides no diagnostic yield in patients at low risk for cardiac events
- Indiscriminate perioperative therapy with β-blockers can increase mortality in otherwise stable patients

Perioperative tests and treatments improve outcomes only when targeted at specific patient subsets. Implementation of the American College of Cardiology/American Heart Association perioperative guidelines ensures cost-effective management and promises the greatest benefit for patients.

References:
Perioperative Practice: Time to Throttle Back. Chopra, V., Flanders, S. A., Froehlich, J. B., Lau, W. C., Eagle, K. A. Ann of Int Med, 2009.
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