Measure ID
TEMP-05-OB
Domain
Description

Percentage of patients undergoing cesarean delivery without a body temperature greater than or equal to 36 degrees Celsius (or 96.8 F) documented within the 30 minutes immediately before or 30 minutes after anesthesia end.

Measure Type
Outcome
Available for Provider Feedback
Yes
Threshold
<10%
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

Measure Time Period

30 minutes before anesthesia end to 30 minutes after.

Inclusions

Cesarean Delivery cases (determined by Obstetric Anesthesia Type value codes: 1, 2, 4, 7, 8)

Exclusions

All other procedure types, specifically deliveries performed without cesarean section.

Success Criteria

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 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

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

Risk Adjustment

Pending

Provider Attribution

Primary Provider - Provider(s) present for 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 duation, all providers signed in for the longest duration will be attributed.

MPOG Concept Used
  • 3031     Temperature- Temporal Artery
  • 3050     Temp 1- Unspecified Site
  • 3051     Temp 2- Unspecified Site
  • 3052     Temp 1- Monitoring Site
  • 3053     Temp 2- Monitoring Site
  • 3054     Temperature- Skin
  • 3055     Temperature- Esophageal
  • 3056     Temperature- Blood
  • 3057     Temperature- Tympanic
  • 3058     Temperature- Bladder
  • 3059     Temperature- Nasopharyngeal
  • 3060     Temperature- Axillary
  • 3061     Temperature- Rectal
  • 3533     Temperature Route
  • 50191   Monitoring- Temperature Probe Placed
  • 50192   Monitoring- Temperature Probe Location/Type
  • 50174   Postoperative vital signs
MPOG Phenotypes Used
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.
Measure Authors

 Measure Author

 Institution

 Brooke Szymanski-Bogart, RN

 University of Michigan

 Jay Jeong

 University of Michigan

 Nirav Shah, MD

 University of Michigan

 MPOG OB Subcommittee

 

 

Measure Reviewer(s)
Next Review: 2027
 Date Reviewed  Reviewer  Institution  Summary  QC Vote

  May 22, 2024

 Wandana Joshi, MD

 Christine Warrick, MD

 Dartmouth Medical Center

 University of Utah Hospital

 Review  Modify
Version
Published Date: 08/2021
 Date  Criteria  Revision
     None