Percentage of cases with elevated postoperative Troponin levels or documentation of perioperative myocardial injury.
Postoperative myocardial infarction within 72 hours (as defined by a Troponin I level >3.6 times the 99th percentile upper reference limit, usually no greater than 1.00 ng/mL)1,2 is associated with a significantly increased risk of 30-day mortality. Furthermore, any amount of postoperative myocardial injury (as defined by a Troponin I level > 0.03 ng/mL) is an independent predictor of 30-day mortality.3 Preventing myocardial infarction is an important anesthetic goal.
Anesthesia End to 72 hours after Anesthesia End
All anesthetic cases.
*Rationale for excluding patient with troponin elevation within 42 days prior to date of surgery is based upon ACC/AHA guidelines recommending a delay in elective surgery for 6 weeks following myocardial infarction.4
In cases with Troponin I or Troponin T value(s) available within 72 hours after anesthesia end, all values must be less than or equal to the following:
If no Troponin I (or Troponin T) values are available within 72 hours after anesthesia end and there is no documentation of perioperative myocardial injury (MPOG Concepts: 90201, 90202), the case will not be flagged (ie we presume no myocardial injury).
Algorithm for determining Case Duration:
To evaluate provider-level risk adjustment we will calculate the observed to expected outcomes ratio (O/E). The O/E is calculated using a logistic regression model and predicts (given a set list of dependent patient and hospital level variables) the expected probability of having an elevated Troponin I level. We adjust for surgery risk score, emergent procedures, ASA, gender, age, body mass index, laboratory values, and teaching versus private hospital. Patient specific comorbidities are evaluated as well.
Providers assigned to patient for the longest duration of the case unless there are providers responsible for flagging BP 01 during case. In that case, BP 01 attribution takes precedence over longest duration. See ‘Other Measure Build Details’ section of this specification to view the algorithm used for determining case duration.
|Date Reviewed||Reviewer||Institution||Summary||QC Vote|
Andrea Reidy, MD
Michael Andrawes, MD
Mass General Hospital
|03/16/2022||Exclusion||Modified cardiac exclusion to use Cardiac phenotype|
|11/12/2019||Success||Added Troponin T values (ID: 3392, 3397, 3401)|
|04/15/2019||Inclusion||New concept ID 3396 (Troponin ng/L); Include cases with Troponin I value with '<' character up to '<0.31'|