Percentage of adult patients undergoing an open cardiac procedure for whom any core temperature at the end of the case ≤ 35.5° C (or 95.9° F). 

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 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 in both the non-cardiac^3-9 and cardiac surgical populations.^10-19 Such adverse effects are prevented through maintenance of normothermia intraoperatively,^3-4 yet, specifically in the cardiac surgical setting hyperthermia is also detrimental and should be avoided.^{10-13,15,18,19}

Measure Start: 

1. Cardiopulmonary Bypass Initiated (ID:50410), if not present, 
2. Cardiopulmonary Bypass Start Phenotype

Measure End: 30 minutes after Anesthesia End

*For cases without bypass: Anesthesia End to 30 minutes after Anesthesia End 

Adult patients undergoing open cardiac surgical procedures (determined by Procedure Type: Cardiac value code: 1)

• Age <18 years
• ASA 6 including Organ Procurement (CPT: 01990)
• Non-cardiac, Transcatheter/Endovascular, EP/Cath, and Other Cardiac cases (determined by Procedure Type: Cardiac value codes: 0, 2, 3, and 4)

Last non-artifact body temperature ≥ 35.5 degrees Celsius (or 95.9 degrees Fahrenheit) at Anesthesia End

(Prioritizes core temperature measurements)

• Temperature documented within the anesthetic record or temperatures documented and mapped to the temperature physiologic concepts are acceptable sources for this measure. Temperatures mapped to MPOG note concept (50174 Postoperative Vital Signs) will only be used if no other core or non-core temperatures are found during the time period. 

• Conversion algorithm for 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

• All core temperature measurements will be prioritized over near-core temperature measurements with hierarchy applied in the following order:
  • Bladder (core)
  • Rectal (core)
  • Blood (core) or PA catheter (core)
  • Nasal (core)
  • Esophageal (core)
  • Zero flux thermometer (near core)
  • Other non-core routes (axillary, oral, skin, temporal, tympanic)

Temperatures will be assessed as follows:

1. Assess the last non-artifact temperature within the time period of 30 minutes before Anesthesia End and after Cardiopulmonary Bypass End. (For cases where Cardiopulmonary Bypass End time = Anesthesia End time, measure will assess the last temperature before bypass end time, looking for a temperature up to 30 minutes before bypass end time.)
2. Assess if temperature is core or non-core using routes listed above. If route is not documented, it is assumed to be non-core.
   • Non-core temperature: move to step 3.
   • Core temperature ≥ 35.5 degrees Celsius -> Case Passes. 
   • Core temperature < 35.5 degrees Celsius, move to step 4.
   • No temperature found: move to step 4.
3. Assess for a core temperature within 15 minutes before the non-core temperature.
   • If core temperature found within 15 minutes before non-core temperature, use the latest non-artifact core temperature (closest in time to the non-core temperature) to assess measure success.
     • Core temperature ≥ 35.5 degrees Celsius -> Case Passes. 
     • Core temperature < 35.5 degrees Celsius, move to step 4.
   • If core temperature is not found within 15 minutes before the non-core temperature, use the last non-artifact non-core temperature to assess measure success. 
     • Non-core temperature ≥ 35.5 degrees Celsius -> Case Passes. 
     • Non-core temperature < 35.5 degrees Celsius-> Case Flagged.
4. Assess for a non-artifact temperature documented within 30 minutes after Anesthesia End, prioritizing temperatures closer to Anesthesia End first.
   • Core temperature ≥ 35.5 degrees Celsius -> Case Passes. 
   • Core temperature < 35.5 degrees Celsius-> Case Flagged.
   • Non-core temperature: move to step 5.
   • No temperature found: Case Flagged - Temperature not documented.
5. Assess if there is a core temperature within 15 minutes after the non-core temperature.
   • If core temperature is found within 15 minutes after the non-core temperature, use the earliest non-artifact core temperature (closest in time to the non-core temperature) to assess measure success. 
     • Core temperature ≥ 35.5 degrees Celsius -> Case Passes. 
     • Core temperature < 35.5 degrees Celsius-> Case Flagged.
   • If core temperature within 15 minutes is not found within 15 minutes after the non-core temperature, use the earliest non-core temperature documented after anesthesia end to determine measure success. 
     • Non-core temperature ≥ 35.5 degrees Celsius -> Case Passes. 
     • Non-core temperature < 35.5 degrees Celsius-> Case Flagged.

Not applicable.

Any provider signed in for ≥40 minutes from bypass end until Anesthesia End.

If bypass end to Anesthesia End is <40 minutes, the provider signed in for the greatest number of minutes during this period (per staff role) will be attributed.  

If bypass was not used, the window would be expanded to any provider signed in for ≥40 minutes for the entire case. 

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.

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.
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