BP-03

This measure is calculated based on data extracted from the electronic medical record combined with administrative data sources such as professional fee and discharge diagnoses data. This measure is explicitly not based on provider self-attestation.

Process

Percentage of cases where intraoperative hypotension (MAP < 65 mmHg) was sustained for less than 15 minutes

Intraoperative. See ‘Other Measure Build Details’ for more information

All patients requiring anesthesia, general, neuraxial, monitored anesthesia care (MAC), or regional.

• Patients < 18 years old
• ASA 5 and 6 cases
• Baseline MAP < 65 mmHG (Highest MAP documented under MPOG concepts 71120, 70211, 70212)
• Daily Hospital Management for Epidural (CPT: 01996)
• Obstetric Non-Operative Procedures (CPT: 01958)
• Labor Epidurals as determined by the MPOG ‘Obsteric Anesthesia Type‘ phenotype results ‘Labor Epidural’ and ‘Conversion (Labor Epidural Portion)’
• Organ Harvest (CPT:01990)
• Cardiac surgery with pump and <1 year old (CPT: 00561)
• Cardiac surgery with pump and > 1 year old (CPT: 00562)
• Cardiac surgery with hypothermic arrest (CPT: 00563)
• CABG with pump (CPT: 00567)
• CABG without pump (CPT: 00566)
• Heart Transplant (CPT: 00580)
• Liver Transplants 
• Lung Transplants 
• Unlisted Anesthesia Procedures (CPT: 01999)
• Cases where the ‘Measure End Time’ precedes ‘Measure Start Time’ will be excluded and marked ‘invalid’

• MAP <65mmHG that does not exceed cumulative time of 15 minutes OR
• MAP >65mmHG throughout case length.

• BP 03 measures the cumulative time of Mean Arterial Pressure (MAP) <65mmHG for a given case and provider. BP 03 includes non-invasive and invasive blood pressure monitoring captured using automated and manually entered physiologic data.
• 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: if systolic and diastolic blood pressures are present, the values must be at least 5 mmHg apart; otherwise the values will be excluded. MAP values less than 10 are excluded.
• Each incidence of MAP <65 will attribute the responsible provider for a max of 5 minutes
• To determine how many minutes the last BP documented accounts for, the difference between the time of the blood pressure and the “Measure End Time” algorithm is used. As with the duration of other BPs, this duration is also capped at 5 minutes.

Measure Start Time:

First Blood Pressure Reading after the latest of these 3 times:

1. First documented Anesthesia Start time.
2. First documented Patient in Room time.
3. First documented Data Capture Start time.

* For labor epidurals which convert to cesarean deliveries where the procedures are combined under one case ID, ‘Cesarean Delivery Start Time‘ is used as the ‘Measure Start Time’

Measure End Time:

1. Patient Out of Room. If not available,
2. Data Capture End. If not available,
3. Anesthesia End.

* For labor epidurals which convert to cesarean deliveries where the procedures are combined under one case ID, the latest ‘data capture end’ is used as the ‘Measure End Time’ when appropriate (all other cases use logic from ‘Data Capture End‘ phenotype)

All providers for a given case whose individual cumulative MAP < 65mmHG exceeds the 15-minute timeframe.

90%

3011	BP Sys Invasive Unspecified Site 1	3040	BP Mean Arterial Line (Invasive, Peripheral)
3012	BP Dias Invasive Unspecified Site 1	3041	BP Sys Invasive Unspecified Site 2
3013	BP Mean Invasive Unspecified Site 1	3042	BP Dias Invasive Unspecified Site 2
3015	BP Sys Non-invasive	3043	BP Mean Invasive Unspecified Site 2
3020	BP Dias Non-invasive	3046	BP Sys Invasive Unspecified Site 3
3025	BP Mean Non-invasive	3047	BP Dias Invasive Unspecified Site 3
3026	BP Sys Invasive Unspecified Site 4	3048	BP Mean Invasive Unspecified Site 3
3027	BP Dias Invasive Unspecified Site 4	3475	BP Sys Invasive Unspecified Site 5
3028	BP Mean Invasive Unspecified Site 4	3476	BP Dias Invasive Unspecified Site 5
3030	BP Sys Arterial Line (Invasive, Peripheral)	3477	BP Mean Invasive Unspecified Site 5
3035	BP Dias Arterial Line (Invasive, Peripheral)	3041	BP Sys Invasive Unspecified Site 2

• Percentage of Physiologic Observations with a Meaningful Type Mapping
• Percentage of Cases with Invasive Blood Pressure
• Percentage of Cases with Non-invasive Blood Pressure
• Percentage of Cases with Physiologic Observations
• Percentage of Physiologic Rows that are Machine Captured
• Percentage of Cases with any Staff Tracking
• Percentage of Anesthesia Provider Sign-Ins that are Timed

Intraoperative hypotension (MAP < 65mmHg) is associated with compromised organ perfusion and puts patients at risk for post-operative mortality, cardiac adverse events (CAEs) and acute kidney injury (AKI). Multiple studies have addressed the impact of hypotension on patient outcomes and generally show less CAEs, AKI, and death by maintaining a MAP above 60-70mmHg.^1,2 One retrospective cohort analysis, including 57,315 non-cardiac surgical patients, demonstrated a MAP of less than 65mmHg was associated with a higher incidence of myocardial and kidney injury and the duration of low MAP significantly increases the odds of the aforementioned outcomes.³ Furthermore, a retrospective review including 33,330 non-cardiac surgical patients determined that a MAP less than 65mmHg for any duration was associated with similar adverse outcomes⁴

Not applicable.

1. Sessler DI, Bloomstone JA, Aronson S, et al. Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery. British journal of anaesthesia. 2019;122(5):563-574.
2. Sessler DI, Khanna AK. Perioperative myocardial injury and the contribution of hypotension. Intensive care medicine. 2018;44(6):811-822.
3. Salmasi V, Maheshwari K, Yang D, et al. Relationship between Intraoperative Hypotension, Defined by Either Reduction from Baseline or Absolute Thresholds, and Acute Kidney and Myocardial Injury after Noncardiac Surgery: A Retrospective Cohort Analysis. Anesthesiology. 2017;126(1):47-65.
4. 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.