Percentage of patients where intraoperative hypotension (MAP < 55 mmHg) was avoided (defined as <20 minutes cumulatively).

Intraoperative hypotension is associated with compromised organ perfusion and puts patients at risk for post-operative mortality, cardiac adverse events (CAEs), acute kidney injury, and stroke. Multiple studies have demonstrated the association of a decreased mean arterial pressure and postoperative morbidity and mortality. One retrospective review included 33,000 non-cardiac surgical patients and determined that a mean arterial pressure less than 55mmHG predicted CAEs and adverse renal-related outcomes⁶. This was confirmed by a distinct investigation of 5000 patients using invasive blood pressure measurement⁵.

Anesthesia Start to Patient out of room (See 'Other Measure Build Details' for more information.)

All adult patients requiring anesthesia.

• Age <18 years
• ASA 5 & 6 including Organ Procurement (CPT: 01990)
• Baseline MAP < 60 mmHG as determined by Preop Blood Pressure - Mean; If preop blood pressure not available, will use Blood Pressure Mean - First in Room)
• Procedures:
  • Labor Epidurals (determined by the Obstetric Anesthesia Type value codes: 3 & 6) including obstetric non-operative procedures (CPT: 01958)
  • Liver Transplants 
  • Lung Transplants 
  • Open cardiac cases as determined by the Procedure Type: Cardiac value code: 1

• MAP <55mmHG that does not exceed cumulative time of 20 minutes OR
• MAP ≥55mmHG throughout case length.

Measure Start Time:

First Blood Pressure Reading after the latest of these 3 times:

1. First documented Anesthesia Start 
2. First documented Patient in Room 
3. First documented Data Capture Start 

* For cesarean delivery cases converted from labor epidural (as determined by Obstetric Anesthesia Type value code:1): Cesarean Delivery Start Time is used as the 'Measure Start Time'

Measure End Time:

1. Patient Out of Room. If not available,
2. Data Capture End. If not available,
3. Anesthesia End.

* For cesarean delivery cases converted from labor epidural (as determined by Obstetric Anesthesia Type value code:1): The latest Data Capture End (Concept ID: 50379) is used as the 'Measure End Time.' 

• This measure relies upon the Blood Pressure Observations phenotype to determine BP values for inclusion during the measure time period. Artifact processing is handled by the phenotype. Any value determined to be artifact will not be considered. If there are multiple MAP values for a given minute and one is determined to be artifact, the non-artifact value will be used.  
• Instances where there are two blood pressure monitoring methods, the higher MAP will be used to determine measure compliance. 
• If there is a gap in blood pressure monitoring, the last MAP prior to the gap will be applied for up to 5 minutes. Therefore, each incidence of MAP <55 can attribute the responsible provider for a max of 5 minutes. 
  • If the gap in blood pressure monitoring is at the end of the measure time period, the last documented MAP will be applied for up to 5 minutes or until the Measure End Time, whichever accounts for the least number of minutes. 

*This measure will include only valid MPOG cases as defined by the Is Valid Case phenotype.

Not applicable.

All providers for a given case whose individual cumulative MAP < 55mmHG exceeds 20 minutes.

1. Bijker JB, Persoon S, Peelen LM, Moons KG, Kalkman CJ, Kappelle LJ, van Klei WA. Intraoperative hypotension and perioperative ischemic stroke after general surgery: a nested case-control study.
2. Anesthesiology. 2012 Mar 116(3): 658-64. doi: 10.1097/ALN.0b013e3182472320. PMID: 22277949
3. Bijker JB, van Klei WA, Vergouwe Y, Eleveld DJ, van Wolfswinkel L, Moons KG, Kalkman CJ. Intraoperative hypotension and 1-year mortality after noncardiac surgery.
4. Anesthesiology. 2009 Dec 111(6): 1217-26. doi: 10.1097/ALN.0b013e3181c14930. PMID: 19934864
5. Sun LY, Wijeysundera DN, Tait GA, Beattie WS. Association of Intraoperative Hypotension with Acute Kidney Injury after Elective Noncardiac Surgery Anesthesiology. 2015 Sep123(3): 515-23. doi: 10.1097/ALN.0000000000000765. PMID: 26181335
6. Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN et al. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: Toward an empirical definition of hypotension. Anesthesiology 2013; 119:507-515. Doi: 10.1097/ALN.0b013e318a10e26. PMID: 23835589.