MPOG Cardiac Anesthesia Subcommittee Meeting
October 9, 2020
Agenda
• Welcome & interim updates
• Basecamp forum
• MPOG-STS data integration and potential for QI
• Proposed topic variation data overview
• Discussion of measure to develop first
• Introduction to the cardiac dashboard
• 2020-21 Plans & Goals
• Subcommittee Membership and Future Meeting Schedule
Introductions
• ASPIRE Quality Team
– Nirav Shah, MD – MPOG Director of Quality
– Michael Mathis, MD – MPOG Director of Research
– Kate Buehler, MSN – Clinical Program Manager
– Allison Janda, MD – MPOG Cardiac Anesthesia Subcommittee Lead
• Cardiac Anesthesiology Representatives joining us from around the US!
MPOG
Research
Quality
(ASPIRE)
MPOG and the Subcommittees
Basecamp
• We will be using Basecamp to communicate
• Please accept your Basecamp invitations (sent via email) to stay in the loop
Benefits of MPOG-NSQIP and -STS Integrations
• Merges the benefits of all databases and registries
• Granular intraop. data
• Medication
doses/times
• Physiologic data
• Ventilator data
• Administrative data
• ICD9/10 codes
• Detailed procedure
type & surgical data
• Adjudicated patient
history and preop.
status variables
• Adjudicated postop.
outcomes
• Labs
• Demographics
• Lab-based
outcomes
MPOG and STS Integrations
• STS-Adult Cardiac Surgical Database (STS-ACSD, aka “STS Cardiac”)
– 3 sites
• STS-General Thoracic Surgical Database (STS-GTSD, “STS Thoracic”)
– 8 sites
• STS-INTERMACS (LVAD database)
– Tentative
• More STS-MPOG integrated sites are in the pipeline!
Where to start?
• Consult the Surgical Registry page and the FAQ
– Surgical Registry page: https://mpog.org/surgicalregistries/
– Surgical Registry FAQ: https://mpog.org/surgicalregistriesfaq/
Individual Performance E-mails
Call for measure survey results overview
• 16 providers completed the survey – Thank you!
• Highest rated measures (no overwhelming consensus)
#1: Post-bypass hypothermia avoidance (62% listed in the top 3)
#2: Glucose management (56% listed in the top 3)
#3: Postoperative AKI avoidance (44% listed in the top 3)
#4: Hypotension avoidance (44% listed in the top 3)
#5: Antibiotic timing (38% listed in the top 3)
• FYI: MPOG data capture - measure limitations
– 4 Hours before Anesthesia Start 6 hours after Anesthesia End
Post-bypass hypothermia avoidance
• Current TEMP-03 Measure:
– % of patients, with procedures >60 minutes under
GA/neuraxial, with at least one body temperature ≥ 36
o
C
– Excludes cardiac surgeries
• Considerations in new measure development:
– Threshold?
– Timing (post-CPB)?
– Exclusions for specific cardiac cases (e.g. spinal protection w/
thoracic aortic)?
Variation data - post-bypass hypothermia avoidance
Variation data - post-bypass hypothermia avoidance >35.5 C
• Mean: 85%
• SD: 13%
Variation data - post-bypass hypothermia avoidance >36 C
• Mean: 66%
• SD: 21%
Variation data - post-bypass hypothermia avoidance >36.5 C
• Mean: 35%
• SD: 19%
Variation data - post-bypass hypothermia avoidance >38 C
Glucose management
• Current GLU-01 Measure:
– % of cases with perioperative glucose > 200 mg/dL with
administration of insulin or glucose recheck within 90
minutes of original glucose measurement
• Considerations:
– Lower glucose threshold?
– Set a shorter threshold for rechecks or are we just
concerned with treatment?
– Initiation of an insulin infusion or treatment
requirement?
Variation data - glucose management, maximum glucose
Variation data - glucose management, >200 w/treatment or recheck
• Adapted GLU-01 Measure:
– % of cases with perioperative glucose > 200 mg/dL with administration of
insulin or glucose recheck within 60 minutes of original glucose measurement
– Mean: 85% SD: 11%
Variation data - glucose management, >180 w/treatment or recheck
• Adapted GLU-01 Measure:
– % of cases with perioperative glucose > 180 mg/dL with administration of
insulin or glucose recheck within 60 minutes of original glucose measurement
– Mean: 79% SD: 14%
Variation data - glucose management, >150 w/treatment or recheck
• Adapted GLU-01 Measure:
– % of cases with perioperative glucose > 150 mg/dL with administration of
insulin or glucose recheck within 60 minutes of original glucose measurement
– Mean: 64% SD: 18%
Which measure to pursue?
• Considerations in new measure development:
– Threshold?
– Timing?
– Exclusions for specific cardiac cases?
– Attribution?
Cardiac-Specific Reporting Dashboard
Cardiac-Related Resources
• AKI Toolkit
– Includes 6 tools
– One is cardiac-specific
• Feedback?
Goals
• Build 1 cardiac-specific measure in 2020/early 2021
– Glucose management?
– Post-bypass hypothermia avoidance?
• Build 2-3 cardiac-specific measures in 2021
– Glucose management?
– Post-bypass hypothermia avoidance?
– Antibiotic timing?
• More discussion
– Hypotension avoidance
– AKI avoidance
• Opportunities for STS-merged outcome reports requires institutions to integrate with STS
Cardiac Anesthesia Subcommittee Membership
• Open to all anesthesiologists or those interested in improving cardiothoracic measures
– Do not have to practice at an active MPOG institution
• Proposed 2020 – 2021 Meeting Schedule
– Winter 2021 Meeting: January, 2021
– Spring 2021 Meeting: April, 2021
• Thank you for using the forum for discussion between meetings!
THANK YOU!
Allison Janda, MD
MPOG Cardiac Anesthesia
QI Subcommittee Lead
ajanda@med.umich.edu
