Measure Abbreviation
FLUID-01-NC
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
Process
Description

Percentage of non-cardiac cases in which colloids were not administered intraoperatively.

Measure Time Period

Anesthesia Start to Anesthesia End

Inclusions
  • All patients undergoing general anesthetics, spinals, and epidurals.
Exclusions
  • ASA 5 and 6 cases
  • ≥2L EBL
  • ≥ 4 units PRBC transfusion
  • Patients that are in prone position for more than 4 hours
  • Patients that are in Trendelenburg position for more than 4 hours
  • Patients with ascites
  • In Vitro Fertilization- Egg Retrieval cases (Surgical CPT: 58970, 58974, 58976)
  • In Vitro Fertilization- Egg Retrieval Rooms (Rooms tagged as IVF-Only) 
  • Cardiac surgery without pump (CPT: 00560)
  • Cardiac surgery with pump and <1 year old (CPT: 00561)
  • Cardiac surgery with pump and > 1 year old (CPT: 00562)
  • Cardiac surgery with hypothermic arrest (CPT: 00563)
  • CABG with pump (CPT: 00567)
  • Heart Transplant (CPT: 00580)
  • Any cardiac case with an intraoperative note mapped to one of the following MPOG Concepts:
    • 50399    Cardiopulmonary bypass -- aortic clamp on/off note
    • 50409    Cardiopulmonary bypass terminated
    • 50410    Cardiopulmonary bypass initiated (full)
    • 50416    Cardiopulmonary bypass -- crossclamp and circulatory arrest time totals
    • 50417    Cardiopulmonary bypass -- Access cannula removed note
    • 50714    Cardiopulmonary bypass - Bypass start / stop event
  • Cases performed by cardiac surgical service: MPOG concept 80005.
Success

Colloids are not administered during the case.

Other Measure Build Details
  • The purpose of this measure is to identify the use of colloids for patients that likely do not need them in the non-cardiac surgery patient population.  It is the expectation that providers will uphold the ASA’s Choosing Wisely program by avoiding colloids and using crystalloid instead when appropriate.
  • Measure Start/End Time is defined as Anesthesia Start to Anesthesia End.
Responsible Provider

The provider signed in at the time of the colloid administration.

Threshold
None
MPOG Concept IDs Required

Colloid MPOG Concepts

Patient Position MPOG Concepts

Patient Dx MPOG Concepts

10017

Albumin 25%

50136

Positioning- Patient Position

10500

Ascites

10018

Albumin 5%

50137

Positioning- Patient positioned in left lateral decubitus position

Estimated Blood Loss MPOG Concept

10557

Albumin 20%

50818

Patient positioned in right lateral decubitus position

10499

EBL

10458

Hetastarch

Blood Administration MPOG Concepts

 

10459

Pentastarch

10489

Packed Red Blood Cells-Autologous

 

10601

Hydroxyethyl Starch 130/0.4 6% in 0.9% Saline (Voluven)

10490

Packed Red Blood Cells- Homologous

 

10605

Hydroxyethyl Starch 6% in Lactated Solution (Hextend)

10616

Packed Red Blood Cells-Unknown Type

 

Data Diagnostics Affected
  • Percentage of Cases with any Fluid Recording
  • Percentage of Fluids with a Meaningful Fluid Mapping
  • Percentage of Cases with Colloids Administered
Rationale

There is a lack of consistent evidence to suggest improved survival with the use of colloids as compared to crystalloids in the surgical population. Because colloids are more expensive than crystalloids, it is recommended that anesthesia providers avoid the use of colloids in most instances. Evidence to support the use of hydroxyethyl starch to prevent ovarian hyperstimulation syndrome for In Vitro Fertilization cases has been published and these cases will be excluded.

Risk Adjustment

Not applicable.

References
  1. Nolan JP, Mythen MG.  Hydroxyethyl starch: here today, gone tomorrow.  British Journal of Anaesthesia 2013, 111(3): 321–4.  doi:10.1093/bja/aet294.
  2. Perel P, Roberts I, Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients. The Cochrane database of systematic reviews. 2013(2):Cd000567.
  3. Schick M, Isbary J, Stuber T, Brugger J, Stumpner J, Schkegel N, Roewer N, Eichelbronner O, Wunder C.  Effects of crystalloids and colloids on liver and intestine microcirculation and function in cecal ligation and puncture induced septic rodents. BMC Gastroenterology 2012, 12:179.  http://www.biomedcentral.com/1471-230X/12/179.
  4. Youssef MA, Al-Inany HG, Evers JL, Aboulghar M. Intra-venous fluids for the prevention of severe ovarian hyperstimulation syndrome. Cochran Database Systematic Reviews 2011, 16(2): CD001302. Doi: 10.1002/14651858.CD001302.pub2.
  5. Ertmer, Christian, Bernhard Zwißler, Hugo Van Aken, Michael Christ, Fabian Spöhr, Axel Schneider, Robert Deisz, and Matthias Jacob. 2018. “Fluid Therapy and Outcome: A Prospective Observational Study in 65 German Intensive Care Units between 2010 and 2011.” Annals of Intensive Care 8 (1): 27.
  6. Futier, Emmanuel, Matthias Garot, Thomas Godet, Matthieu Biais, Daniel Verzilli, Alexandre Ouattara, Olivier Huet, et al. 2020. “Effect of Hydroxyethyl Starch vs Saline for Volume Replacement Therapy on Death or Postoperative Complications Among High-Risk Patients Undergoing Major Abdominal Surgery: The FLASH Randomized Clinical Trial.” JAMA: The Journal of the American Medical Association 323 (3): 225–36.
  7. Joosten, Alexandre, Amelie Delaporte, Brigitte Ickx, Karim Touihri, Ida Stany, Luc Barvais, Luc Van Obbergh, et al. 2018. “Crystalloid versus Colloid for Intraoperative Goal-Directed Fluid Therapy Using a Closed-Loop System: A Randomized, Double-Blinded, Controlled Trial in Major Abdominal Surgery.” Anesthesiology 128 (1): 55–66.
  8. Joosten, Alexandre, Amélie Delaporte, Julien Mortier, Brigitte Ickx, Luc Van Obbergh, Jean-Louis Vincent, Maxime Cannesson, Joseph Rinehart, and Philippe Van der Linden. 2019. “Long-Term Impact of Crystalloid versus Colloid Solutions on Renal Function and Disability-Free Survival after Major Abdominal Surgery.” Anesthesiology 130 (2): 227–36.
  9. László, Ildikó, Ágnes Janovszky, András Lovas, Viktória Vargán, Nándor Öveges, Tamás Tánczos, András Mikor, et al. 2019. “Effects of Goal-Directed Crystalloid vs. Colloid Fluid Therapy on Microcirculation during Free Flap Surgery: A Randomised Clinical Trial.” European Journal of Anaesthesiology 36 (8): 592–604.
  10. Martin, Greg S., and Paul Bassett. 2019. “Crystalloids vs. Colloids for Fluid Resuscitation in the Intensive Care Unit: A Systematic Review and Meta-Analysis.” Journal of Critical Care 50 (April): 144–54.