Measure Abbreviation
TEMP-05-OB
Data Collection Method

This measure is calculated based on data extracted from the electronic health record supplemented with  complementary data sources such as professional fee and discharge diagnoses data.

Measure Type
Outcome
Description

Percentage of patients who undergo cesarean deliveries under general or neuraxial anesthesia for whom no body temperature was greater than or equal to 36 degrees Celsius (or 96.8 F) recorded within the 30 minutes immediately before or the 15 minutes immediately after the case

Measure Time Period

30 minutes before ‘anesthesia end’ to 15 minutes after

Inclusions
  • Cesarean Delivery cases as determined by the “Obstetric Anesthesia Type” Phenotype. Phenotype results included:
    • Cesarean Delivery
    • Conversion (Cesarean Delivery Portion)
    • Conversion (Labor epidural and cesarean delivery combined)
    • Cesarean Hysterectomy
    • Conversion (Cesarean Hysterectomy Portion)
Exclusions
  • Invalid cases where Measure End results prior to Measure Start
Success

At least one body temperature measurement equal to or greater than 36 degrees Celsius (or 96.8 degrees Fahrenheit) achieved within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time.

 

Other Measure Build Details

Cases with no temperature measurements within the measurement period will be marked as flagged

Temperature documented within the postoperative vital sign note in the anesthetic record or temperatures documented and mapped to the temperature physiologic concepts are acceptable sources for this measure. 

Conversion from F to C:    F=32 +9/5 (°C)

Artifact algorithm:

  • Less than 32.0°C (89.6F)
  • Greater than 40.0°C (104.0F)
  • Any minute-to-minute jumps >0.5°C equivalent. 
    • Example: 0.125°C /15s, 0.25°C / 30s, 1°C / 2mins
Responsible Provider

Provider present for the longest duration of the case per staff role. In the event that two or more providers in the same class are signed in for the same duration, all providers signed in for the longest duration will be attributed.

 

Threshold
<10%
MPOG Concept IDs Required

Temperature MPOG Concept IDs

3050

Temp 1- Unspecified Site

3051

Temp 2- Unspecified Site

3052

Temp 1- Monitoring Site

3053

Temp 2- Monitoring Site

3031

Temperature- Temporal Artery

3054

Temperature- Skin

3055

Temperature- Esophageal

3056

Temperature- Blood

3057

Temperature- Tympanic

3058

Temperature- Bladder

3059

Temperature- Nasopharyngeal

3060

Temperature- Axillary

3061

Temperature- Rectal

50174

Postoperative vital signs

Data Diagnostics Affected
  • Cases with a Temperature Observation
  • Cases with Staff Tracking
  • Staff Role Mapping
  • Staff Sign-Ins are Timed
Rationale

Perioperative hypothermia is defined as a core temperature less than 36 degrees Celsius by both the National Institute of Health and Clinical Excellence and the American Heart Association.1,2 Maternal hypothermia has been reported to occur in 10.7-48% of cesarean deliveries.3-6 Temperatures <36 degrees celsius in the immediate postoperative period are more common in elective versus emergent deliveries and with spinal anesthesia as compared to epidural anesthesia.4,6 It is not uncommon for a patient’s core temperature to drop during surgery due to anesthetic induced peripheral vasodilation, exposure of skin during the surgical prep, or impaired heat distribution. Perioperative hypothermia can result in multiple adverse effects including surgical site infections, cardiovascular events, impaired wound healing and increased hospital length of stay.7-12  Recent studies have shown no significant impact from maternal warming  on neonatal outcomes such as Apgar scores, neonatal temperature at birth, and umbilical vein pH, although active maternal warming has been associated with higher neonatal umbilical artery pH.3,5,13 Maternal temperature < 36 degree celsius at  delivery has been associated with increased risk of neonatal hypothermia in preterm infants 5 minutes after delivery.14 Maternal obesity, oxytocin augmentation of labor, and use of active warming are shown to decrease the risk of maternal hypothermia. Conversely, maternal temperature <37.1 upon arrival to the operating room, maternal temperature <36.6 at time of incision, and a total infused volume of >650mL of unwarmed fluids are significantly associated with maternal hypothermia.4

 

Risk Adjustment

N/A

References
  1. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Journal of the American College of Cardiology. 2014;64(22):e77-137.
  2. National Collaborating Centre for N, Supportive C. National Institute for Health and Clinical Excellence: Guidance. The Management of Inadvertent Perioperative Hypothermia in Adults. London: Royal College of Nursing (UK)National Collaborating Centre for Nursing and Supportive Care.; 2008.
  3. Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008;109(2):318-338.
  4. Sun Z, Honar H, Sessler DI, et al. Intraoperative core temperature patterns, transfusion requirement, and hospital duration in patients warmed with forced air. Anesthesiology. 2015;122(2):276-285.
  5. Carpenter L, Baysinger CL. Maintaining perioperative normothermia in the patient undergoing cesarean delivery. Obstetrical & gynecological survey. 2012;67(7):436-446.
  6. Insler SR, Sessler DI. Perioperative thermoregulation and temperature monitoring. Anesthesiology clinics. 2006;24(4):823-837.
  7. Horn EP, Schroeder F, Gottschalk A, et al. Active warming during cesarean delivery. Anesthesia and analgesia. 2002;94(2):409-414, table of contents.
  8. Yi J, Liang H, Song R, Xia H, Huang Y. Maintaining intraoperative normothermia reduces blood loss in patients undergoing major operations: a pilot randomized controlled clinical trial. BMC anesthesiology. 2018;18(1):126.
  9. Sultan, P., A. S. Habib, Y. Cho, and B. Carvalho. 2015. “The Effect of Patient Warming during Caesarean Delivery on Maternal and Neonatal Outcomes: A Meta-Analysis.” British Journal of Anaesthesia 115 (4): 500–510.
  10. Almeida, Maria Fernanda Branco de, Ruth Guinsburg, Guilherme Assis Sancho, Izilda Rodrigues Machado Rosa, Zeni Carvalho Lamy, Francisco Eulógio Martinez, Regina Paula Guimarães Vieira Cavalcante da Silva, et al. 2014. “Hypothermia and Early Neonatal Mortality in Preterm Infants.” The Journal of Pediatrics 164 (2): 271–75.e1.