Percentage of patients, ≥18 years age, who undergo open cardiac surgical procedures under general anesthesia of 120 minutes duration or longer for whom last non-artifact body temperature measure at the end of the case was not greater than or equal to 35.5 degrees Celsius (or 95.9 degrees Fahrenheit). (Reported as an inverse measure: lower is better.)

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}

30 minutes before Cardiopulmonary Bypass End through 30 minutes after Anesthesia End (for cases without bypass: use 30 minutes before anesthesia start time to 30 minutes after anesthesia end time)

All patients, 18 years of age or older, who undergo open cardiac surgical procedures (as determined by Procedure Type: Cardiac phenotype) under general anesthesia of 120 minutes duration or longer.

• ASA 6 
• Organ harvest (CPT: 01990)
• Non-cardiac, Transcatheter/Endovascular, EP/Cath, and Other Cardiac cases as defined by the Procedure Type: Cardiac phenotype
• Invalid cases where Measure End results prior to Measure Start
• Cases with age <18

Last non-artifact body temperature measure at anesthesia end greater than or equal to 35.5 degrees Celsius (or 95.9 degrees Fahrenheit), prioritizing 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: (Flowchart version)

1. Assess the last non-artifact temperature after bypass end and 30 minutes before anesthesia end. (For cases where bypass end time = anesthesia end time, measure will assess the last temperature 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.
   1. If the last non-artifact temperature before anesthesia end is core, assess if temperature is greater than or equal to 35.5 degrees Celsius. 
      1. If greater than or equal to 35.5 degrees Celsius, case passes.
      2. If less than 35.5 degrees Celsius, continue to assess temperatures up to 30 minutes after anesthesia end. (Move to Step 3.)
   2. If the last non-artifact temperature 30 minutes before anesthesia end is non-core, look for a core temperature within 15 minutes before the non-core temperature. Use the non-artifact core temperature closest in time to the non-core temperature to assess measure success. If no core temperature is found after looking back 15 minutes, use the last non-artifact non-core temperature to assess measure success. 
      1. If core temperature is greater than or equal to 35.5 degrees Celsius, case passes. 
      2. If core temperature (or non-core temperature if a core temperature is not found) is less than 35.5 degrees Celsius, OR no temperature regardless of route is found, continue to assess temperatures up to 30 minutes after anesthesia end. (Move to step 3.)   
   3. If no temperature found within 30 minutes before anesthesia end and after bypass end, move to step 3.
3. Assess for a non-artifact temperature documented within 30 minutes after anesthesia end, prioritizing temperatures closer to anesthesia end first.
   1. If the first non-artifact temperature after anesthesia end is core, assess if temperature is greater than or equal to 35.5 degrees Celisus. 
      1. If greater than or equal to 35.5 degrees Celsius, case passes.
      2. If less than 35.5 degrees Celisus, case is flagged.
   2. If the first non-artifact temperature after anesthesia end is non-core, assess if there is a core temperature within 15 minutes after the non-core temperature. Use the non-artifact core temperature closest in time to the non-core temperature to assess measure success. 
      1. If core temperature is greater than or equal to 35.5 degrees Celsius, case passes.
      2. If core temperature is less than 35.5 degrees Celsius, case is flagged.
      3. If core temperature within 15 minutes is not found, use the first non-core temperature documented after anesthesia end to determine measure success. 
   3. If no temperatures are found within 30 minutes after anesthesia end, case is flagged and results: ‘Temperature not documented.’ 

Not applicable.

Any provider signed in for ≥40 minutes from bypass end until anesthesia end. If the measure time period is less than 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.

Algorithm for determining Measure Attribution Duration:

Window Start:

1. Cardiopulmonary Bypass Terminated (Concept ID: 50409) - will take the latest time if documented more than once on the case.
2. Cardiopulmonary Bypass End. If not available, then
3. Anesthesia Start.

Window End:

1. Anesthesia End. 

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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