ASPIRE Obstetric Anesthesia
Subcommittee Meeting
July 20, 2022
Agenda
● Announcements
● February 2022 Meeting recap
● Review Measure Survey Results
○ Preliminary Data Review to Inform Future Plans
● Finalize 2022-2023 Plans
Announcements
● Next OB Subcommittee Virtual
Meeting:
December 7th, 1pm EST
● MPOG Retreat in New Orleans:
October 21, 2022
February Meeting Recap
● Reviewed unblinded site performance for PONV measures
○ Subcommittee recommended changes to PONV 05 (prophylaxis measure)
● Subcommittee seeking further clarification on the timeframe for MPOG data
before and after cesarean delivery cases
● Survey distributed after the meeting to all subcommittee members to
assess measure focus areas for 2022
PONV 05 Updates since February
● Percentage of patients, aged 18 years and older undergoing a procedure requiring anesthesia and
administered appropriate prophylaxis for postoperative nausea and vomiting, as defined by:
○ For cesarean delivery cases only (any age): At least two prophylactic pharmacologic antiemetic agents
from different classes preoperatively or intraoperatively. (per SOAP ERAS 2021 guidelines)
● Excludes: Labor epidurals
● Risk factors not considered for cesarean delivery patients
● Measure time period update:
○ Was: Cesarean delivery start time for conversion cases & preop start for scheduled c-sections
○ Now: 2 hours before cesarean delivery for conversions & preop start for scheduled c-sections
MPOG Obstetric Data Capture before Surgery
Medication Documentation populated in the MPOG database (data capture rate)*
% of cases with
meds 0-1 hours
before c-section
start
% of cases with
meds 1-2 hours
before c-section
start
% of cases with
meds 2-3 hours
before c-section
start
% of cases with
meds 3-4 hours
before c-section
start
Conversions 44% 44% 42% 39%
Cesarean
Delivery
70% 20% 14% 12%
*Average across all MPOG sites - some sites have more, some less
Future Planning
Survey Results are in!
● 10 Total Respondents
● Questions: Submit your level of interest for each of the proposed measure topics:
■ % of patients with pain ≥3 during labor with epidural (within 60 minutes of
initiation)
● Low interest: 2 respondents
● Moderate interest: 6 respondents
● High interest: 2 respondents
■ % of patients with intraoperative blood product administration
● Low interest: 0
● Moderate interest: 7
● High interest: 3
Survey Results
Submit your level of interest for each of the proposed measure topics:
■ Failed extension of epidural for cesarean delivery
● Low interest: 0 respondents
● Moderate interest: 1 respondents
● High interest: 9 respondents
■ % of cesarean delivery cases with hypotension intervention
● Low interest: 3
● Moderate interest: 3
● High interest: 4
Survey Results: Write-in topics
● In room to induction complete, time from induction to incision, incision to
baby delivered (limited data in MPOG)
● Epidural catheter replacement during labor (data not available in MPOG)
● Labor epidural catheter replacement for cesarean delivery (data not
available in MPOG)
● Appropriate dosing of duramorph Available - prelim data later in
presentation
Preliminary Performance Data
1. This data has been minimally validated
2. Blinded - no site names included
3. Sites with less than 75 cesarean sections in 2021: not represented
4. Topics highlighted:
a. Epidural->General anesthesia
b. Hypotension & treatment of, in cesarean delivery
c. Blood product administration and EBL in cesarean delivery
d. Morphine dosing for spinals/epidurals
Goal - Provide some preliminary results for the measure topics proposed in order to
guide the subcommittee to:
a) Select topics for the next 1-3 obstetric measures
b) Facilitate future measure specification discussions for selected topics
Epidural converted to General Anesthesia
All General Anesthesia Cesarean Delivery Cases
Cesarean delivery with hypotension (SBP<90 for ≥5
minutes)
Cesarean Delivery and Vasopressor Use
Cesarean Delivery: Vasopressor Bolus Only
Cesarean Delivery: Vasopressor Infusion Only
Cesarean Delivery: Vasopressor Bolus + Infusion
Cesarean Delivery: Untreated hypotension
*Data is not validated-
outlier likely due to
documentation or data
capture issue.
Cesarean deliveries with PRBCs administered
Cesarean deliveries with 1-2U PRBCs administered
Cesarean deliveries with 2-3U PRBCs administered
Cesarean deliveries with ≥3U PRBCs administered
Blood Loss in Cesarean Delivery (all)
Epidural Morphine Dosing
Spinal Morphine Dosing
Survey Results
Next Steps
● Vote on measure topics (via Zoom poll)
● Coordinating Center will draft measure specification(s) for selected
topics
● Measure specification(s) will be posted via Basecamp for
subcommittee to provide feedback
● Goal:
○ Build one additional obstetric-specific measure by end of 2022
○ Build 1-2 obstetric-specific measures in 2023
Launch Poll
Threshold for Inclusion Reporting
● We propose not reporting performance of obstetric measures for
institutions with less than a certain # of cesarean deliveries/year
○ Threshold?
○ Would only apply to bar graph comparisons for Obstetric Subcommittee
meetings
○ Individual and departmental dashboards would still display any included cases
for obstetric measure performance
● Typically low case volume reflects poor cesarean delivery data
capture in MPOG, not necessarily that the site doesn’t perform c-
sections
THANK YOU!
Kate Buehler MS, RN
MPOG Obstetric Subcommittee Lead
MPOG Clinical Program Manager
kjbucrek@med.umich.edu
Monica Servin, MD
MPOG Obstetric Anesthesia
Subcommittee Chair
monicar@med.umich.edu
