Measure ID
BP-03
Domain
Description

Percentage of patients where intraoperative hypotension (MAP < 65 mmHg) was avoided (defined as <15 minutes cummulatively).

Measure Type
Process
Threshold
90%
Rationale

Intraoperative hypotension (MAP < 65mmHg) is associated with compromised organ perfusion and puts patients at risk for post-operative mortality, cardiac adverse events (CAEs) and acute kidney injury (AKI). Multiple studies have addressed the impact of hypotension on patient outcomes and generally show less CAEs, AKI, and death by maintaining a MAP above 60-70mmHg.1,2 One retrospective cohort analysis, including 57,315 non-cardiac surgical patients, demonstrated a MAP of less than 65mmHg was associated with a higher incidence of myocardial and kidney injury and the duration of low MAP significantly increases the odds of the aforementioned outcomes.3 Furthermore, a retrospective review including 33,330 non-cardiac surgical patients determined that a MAP less than 65mmHg for any duration was associated with similar adverse outcomes4

Measure Time Period

Intraoperative. See ‘Other Measure Build Details’ for more information.

Inclusions

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

Exclusions

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

Success Criteria
  • MAP <65mmHG that does not exceed cumulative time of 15 minutes OR
  • MAP >65mmHG throughout case length.
Other Measure Details
  • BP 03 measures the cumulative time of Mean Arterial Pressure (MAP) <65mmHG for a given case and provider. BP 03 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 <65 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 the time of the blood pressure and the “Measure End Time” algorithm is used. 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 < 65mmHG exceeds the 15-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. Sessler DI, Bloomstone JA, Aronson S, et al. Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery. British journal of anaesthesia. 2019;122(5):563-574.
  2. Sessler DI, Khanna AK. Perioperative myocardial injury and the contribution of hypotension. Intensive care medicine. 2018;44(6):811-822.
  3. Salmasi V, Maheshwari K, Yang D, et al. Relationship between Intraoperative Hypotension, Defined by Either Reduction from Baseline or Absolute Thresholds, and Acute Kidney and Myocardial Injury after Noncardiac Surgery: A Retrospective Cohort Analysis. Anesthesiology. 2017;126(1):47-65.
  4. Walsh M, Devereaux PJ, Garg AX, et al. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology. 2013;119(3):507-515.
Measure Authors
 Measure Author  Institution

 Nirav Shah, MD

 University of Michigan

 Kate Buehler, RN

 University of Michigan

 Mark Dehring

 University of Michigan

 Sachin Kheterpal, MD

 University of Michigan

 MPOG Quality Committee

 
Measure Reviewer(s)

 

 Date Reviewed  Reviewer  Institution  Summary  QC Vote

 09/26/2022

 Kamal Maheshwari, MD

 Cleveland Clinic

 Review

 No Change 

 

 

Version
Published Date: 09/2019
 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