Measure ID
BP-01
Domain
Description

Percentage of patients where intraoperative hypotension (MAP < 55 mmHg) was sustained for less than 20 minutes.

Measure Type
Process
Threshold
90%
Rationale

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.

Measure Time Period
Inclusions

All patients requiring general anesthesia or monitored anesthesia care (MAC).

Exclusions

*Cases where the ‘Measure End Time’ precedes ‘Measure Start Time’ will be excluded and marked invalid.

Success Criteria
  • MAP <55mmHG that does not exceed cumulative time of 20 minutes OR
  • MAP >55mmHG throughout case length.
Other Measure Details
  • BP 01 measures the cumulative time of Mean Arterial Pressure (MAP) <55mmHG for a given case and provider. BP 01 includes non-invasive and invasive blood pressure monitoring captured using automated and manually entered physiologic data.
  • Instances where there are two blood pressure monitoring methods, the higher MAP will be used to determine measure compliance. 
  • Artifact readings will be identified and removed from final measurement calculation. Artifact processing: if systolic and diastolic blood pressures are present, the values must be at least 5 mmHg apart; otherwise the values will be excluded. MAP values less than 10 are excluded.
  • Each incidence of MAP <55 will attribute the responsible provider for a max of 5 minutes
  • To determine how many minutes the last BP documented accounts for, the difference between it the “Measure End Time” algorithm is used (see page 3). As with the duration of other BPs, this duration is also capped at 5 minutes.

Measure Start Time:

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

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

* For labor epidurals which convert to cesarean deliveries where the procedures are combined under one case ID, '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 labor epidurals which convert to cesarean deliveries where the procedures are combined under one case ID, the latest 'data capture end' is used as the 'Measure End Time' when appropriate (all other cases use logic from 'Data Capture End' phenotype)

Risk Adjustment

Not applicable.

Provider Attribution

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

MPOG Concept Used
  • 3011       BP Sys Invasive Unspecified Site 1
  • 3012       BP Dias Invasive Unspecified Site 1
  • 3013       BP Mean Invasive Unspecified Site 1
  • 3015       BP Sys Non-invasive
  • 3020       BP Dias Non-invasive
  • 3025       BP Mean Non-invasive
  • 3026       BP Sys Invasive Unspecified Site 4
  • 3027       BP Dias Invasive Unspecified Site 4
  • 3028       BP Mean Invasive Unspecified Site 4
  • 3030       BP Sys Arterial Line (Invasive, Peripheral)
  • 3035       BP Dias Arterial Line (Invasive, Peripheral)
  • 3040       BP Mean Arterial Line (Invasive, Peripheral)
  • 3041       BP Sys Invasive Unspecified Site 2
  • 3042       BP Dias Invasive Unspecified Site 2
  • 3043       BP Mean Invasive Unspecified Site 2
  • 3046       BP Sys Invasive Unspecified Site 3
  • 3047       BP Dias Invasive Unspecified Site 3
  • 3048       BP Mean Invasive Unspecified Site 3
  • 3475       BP Sys Invasive Unspecified Site 5
  • 3476       BP Dias Invasive Unspecified Site 5
  • 3477       BP Mean Invasive Unspecified Site 5
  • 3041       BP Sys Invasive Unspecified Site 2
References
  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.
Measure Authors
 Measure Author  Institution

 Nirav Shah, MD

 University of Michigan

 Jamie Osborne, RN

 University of Michigan

 Mark Dehring

 University of Michigan

 Sachin Kheterpal, MD

 University of Michigan

 MPOG Quality Committee

 
Measure Reviewer(s)
Next Review: 2025
 Date Reviewed  Reviewer  Institution  Summary  QC Vote

 09/26/2022

 Kamal Maheshwari, MD

 Cleveland Clinic

 Review

 Modify

 

 

 

Version
Published Date: 11/2015
 Date  Criteria Updated   Revision
 07/12/2022   Exclusion  Added BP First in Room value as backup to Preop Blood Pressure Mean
 06/09/2022   Exclusion  Modified to use new phenotype Preop Blood Pressure Mean
 06/21/2021    Exclusion  Modified to consider Obstetric Anesthesia Type Phenotype; Valid measure duration