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

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

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

• ASA 5 & 6 including Organ Harvest (CPT: 01990)
• Baseline MAP < 60 mmHG (as determined by the Preop Blood Pressure - Mean phenotype; if preop BP not available, will use Blood Pressure Mean - First in Room)
• Patient age <18 years
• Procedures:
  • Labor Epidurals including obstetric non-operative procedures (CPT: 01958)
  • Liver Transplants 
  • Lung Transplants 
  • Open cardiac Cases as determined by the Procedure Type: Cardiac phenotype 

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

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

• 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)

Not applicable.

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

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.