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

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

Anesthesia Start to Anesthesia End

All adult patients requiring anesthesia.

• Age < 18 years
• ASA 5 & 6 including Organ Procurement (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)
• Procedures:
  • Cardiac cases as determined by the Procedure Type: Cardiac value codes: 1 & 4
  • Labor Epidurals (determined by the Obstetric Anesthesia Type value codes: 3 & 6) including obstetric non-operative procedures (CPT: 01958)
  • Liver Transplants 
  • Lung Transplants 

• MAP <65mmHG that does not exceed cumulative time of 15 minutes OR
• MAP ≥65mmHG throughout case length.

• This measure relies upon the Blood Pressure Observations phenotype to determine BP values for inclusion during the measure time period. Artifact processing is handled by the phenotype. Any value determined to be artifact will not be considered. If there are multiple MAP values for a given minute and one is determined to be artifact, the non-artifact value will be used.  
• Instances where there are two blood pressure monitoring methods, the higher MAP will be used to determine measure compliance. 
• If there is a gap in blood pressure monitoring, the last MAP prior to the gap will be applied for up to 5 minutes. Therefore, each incidence of MAP <65 can attribute the responsible provider for a max of 5 minutes. 
  • If the gap in blood pressure monitoring is at the end of the measure time period, the last documented MAP will be applied for up to 5 minutes or until the Measure End Time, whichever accounts for the least number of 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 cesarean delivery cases converted from labor epidural (as determined by Obstetric Anesthesia Type value code: 1): 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 cesarean delivery cases converted from labor epidural (as determined by Obstetric Anesthesia Type value code: 1): The latest Data Capture End (Concept ID: 50379) is used as the 'Measure End Time.' 

*This measure will include only valid MPOG cases as defined by Is Valid Case phenotype.

Not applicable.

All providers for a given case whose individual cumulative MAP < 65mmHG exceeds the 15-minute timeframe.

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.