Percentage of patients where severe hypotension during anesthesia induction (defined as MAP < 55 mmHg) was avoided.

Intraoperative hypotension is associated with compromised organ perfusion and puts patients at risk for post-operative mortality, cardiac adverse events (CAEs), acute kidney injury, and stroke. Multiple studies have demonstrated the association of a decreased mean arterial pressure and postoperative morbidity and mortality.^1-2  One retrospective review included 33,000 non-cardiac surgical patients and determined that a mean arterial pressure less than 55mmHg predicted CAEs and adverse renal-related outcomes.⁵  This was confirmed by a distinct investigation of 5,000 patients using invasive blood pressure measurement.⁴  Specifically around the time of induction, severe hypotension is common and at least partially treatable. One study documenting approximately 26% of older adults undergoing general anesthetic induction experience this outcome³.

Induction Start to Surgery Start.

If Surgery Start not available, Induction End.

Adult patients requiring anesthesia.

• Age < 18 years
• ASA 6 including Organ Procurement (CPT: 01990)
• Baseline MAP < 60 mmHG as determined by Preop BP (if not available then BP First in Room)
• Cases where measure duration is < 5 minutes
• Labor Epidurals (determined by the Obstetric Anesthesia Type value codes: 3 & 6 including obstetric non-operative procedures - CPT: 01958)

MAP > 55mmHG throughout the induction time period

For cesarean section cases, measure start is determined by the Cesarean Delivery Start Time phenotype.

Instances where there are two blood pressure monitoring methods, the higher MAP will be used to determine measure compliance. Artifact readings will be identified and removed from final measurement calculation. Artifact processing will occur according to the Blood Pressure Observations phenotype.

In the measure result details, invasive blood pressure values with MAP <55 mmHg triggering a flagged case will be labeled as ‘invasive'. Noninvasive blood pressure values with MAP < 55mmHg triggering a flagged case will be labeled as ‘noninvasive'. If the case has both noninvasive and invasive blood pressure values with MAP < 55 mmHg during the induction time period, the case will be labeled as ‘invasive'. The number of minutes of MAP<55mmHg during the induction time period will also be resulted.

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

Not Applicable

Provider(s) signed in during induction.

1. Bijker JB, Persoon S, Peelen LM, et al. Intraoperative hypotension and perioperative ischemic stroke after general surgery: a nested case-control study. Anesthesiology. 2012;116(3):658-664.
2. Bijker JB, van Klei WA, Vergouwe Y, et al. Intraoperative hypotension and 1-year mortality after noncardiac surgery. Anesthesiology. 2009;111(6):1217-1226.
3. Schonberger RB, Dai F, Michel G, et al. Association of propofol induction dose and severe pre-incision hypotension among surgical patients over age 65. J Clin Anesth. 2022;80:110846.
4. Sun LY, Wijeysundera DN, Tait GA, Beattie WS. Association of intraoperative hypotension with acute kidney injury after elective noncardiac surgery. Anesthesiology. 2015;123(3):515-523.
5. 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.