Measure Abbreviation
TRAN-02
Data Collection Method

This measure is calculated based on data extracted from the electronic medical record combined with administrative data sources such as professional fee and discharge diagnoses data.  This measure is explicitly not based on provider self-attestation.

Measure Type
Outcome
Description

Percentage of cases with a post transfusion hemoglobin or hematocrit value less than or equal to 10 g/dL or 30%.

Measure Time Period

90 minutes before the last intraoperative transfusion to 18 hours after Anesthesia End

Inclusions

Any patient that receives a red blood cell transfusion. Transfusion is defined as packed red blood cells or whole blood. See MPOG Concept IDs below for complete list.

Exclusions
  • Patients < 2 years of age
  • Patients <21 years old undergoing a cardiac procedure (CPT: 00560, 00561, 00562, 00563, 00567, 00580)
  • Pediatric cases (<12 years old) where either the transfused PRBC or EBL was greater than 30cc/kg.
  • ASA 5 & 6
  • EBL ≥ 2000ml
  • Massive Transfusion: Transfusion of 4 or more units of blood. Note for sites that document transfusions in ml instead of units: ASPIRE will default to 350ml/unit.
  • Obstetric Non-Operative Procedures (CPT: 01958, 01960, 01967)
  • Obstetric Non-Operative Procedures with procedure text: “Labor Epidural”
  • Exclude patients undergoing cesarean section (CPT: 01961, 01968, 01962, 01963, 01969) with an EBL > 1500cc
  • Exclude patients undergoing cesarean section (CPT: 01961, 01968, 01962, 01963, 01969) with a HR>110, SBP<85, DBP<45, or O2Sat <95%.
  • Exclude postpartum hemorrhage cases (ICD-10 code: O72.0, O72.1, O72.2, O72.3)
Success
  • Hematocrit value documented as less than or equal to 30% and/or hemoglobin value documented as less than or equal 10 g/dL     OR
  • No hematocrit or hemoglobin checked within 18 hours of anesthesia end.
Other Measure Build Details
  • Considerations:
    • All hemoglobin/hematocrit lab values drawn after the last transfusion and within 18 hours after anesthesia end will be evaluated. If the lowest of these values is ≤10g/dL or ≤30%, the case will pass.
    • If the hemoglobin or hematocrit at the time of the last transfusion (within 90 minutes before) is less than or equal to 8/24, the case will pass.
Responsible Provider

Individual who administered the transfusion

Threshold
<10%
MPOG Concept IDs Required

Blood Product

MPOG Concept IDs

Point of Care Testing

MPOG Concept IDs

Formal Lab MPOG Concept IDs

EBL MPOG

Concept ID

10489

Packed Red Blood Cells- Autologous

3415

POC-Blood gas-Hct measured

5005

Formal lab- Hemoglobin

10499

EBL

10490

Packed Red Blood Cells- Homologous

3435

POC- hematocrit spun

5006

Formal lab- Hematocrit

 

10492

Whole Blood- Homologous

3440

POC- Coulter counter- Hemoglobin

5038

Formal lab- Blood gas- Hct measured

 

10616

Packed Red Blood Cells- Unknown Type

3450

POC- Coulter counter- Hematocrit

5080

Formal lab- Blood gas- Hemoglobin

10617

Whole Blood- Unknown Type

5081

POC- Blood gas- Hemoglobin

10618

Categorized Note- Blood Products

Data Diagnostics Affected
  • Percentage of Inpatient Cases with Documented Blood Loss
  • Percentage of Cases with Documented Blood Transfusions
  • Percentage of Fluids with a Meaningful Fluid Mapping
  • Percentage of Labs Mapped to a Meaningful Lab Mapping
  • Percentage of Cases with a Lab Drawn During Anesthesia
  • Percentage of Cases with Point of Care Hematocrit Labs
  • Percentage of Cases with Point of Care Hemoglobin Labs
  • Percentage of Cases with any Staff Tracking
  • Percentage of Anesthesia Provider Sign-Ins that are Timed
Rationale

The American Association of Blood Banks (AABB) recommends a transfusion threshold of hemoglobin concentration less than or equal to 8 g/dL or when patient is symptomatic (chest pain, orthostatic hypotension, tachycardia unresponsive to fluid resuscitation, or congestive heart failure).1,2 Furthermore, blood transfusions in non-cardiac surgery have been associated with increased risk of 30-day mortality and morbidity.3,4

Although the literature is not conclusive on the exact hemoglobin concentration that requires transfusion, the evidence is clear that use of fewer RBC transfusions reduces cost and risk for adverse effects of transfusion, and that transfusion to  hemoglobin value greater than 10 g/dL or hematocrit greater than 30 is almost always not indicated.5 TRAN 02 is an outcome measure examining the number of patients who may have received more blood than necessary.  

Risk Adjustment

Not applicable

References

1.            Carson JL, Grossman BJ, Kleinman S, et al. Red blood cell transfusion: a clinical practice guideline from the AABB*. Annals of internal medicine. 2012;157(1):49-58.

2.            Carson JL, Guyatt G, Heddle NM, et al. Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage. Jama. 2016;316(19):2025-2035.

3.            Glance LG, Dick AW, Mukamel DB, et al. Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery. Anesthesiology. 2011;114(2):283-292.

4.            Napolitano LM, Kurek S, Luchette FA, et al. Clinical practice guideline: red blood cell transfusion in adult trauma and critical care. The Journal of trauma. 2009;67(6):1439-1442.

5.            Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management*. Anesthesiology. 2015;122(2):241-275.