MPOG Cardiac Anesthesia Subcommittee Meeting
June 24, 2024
Introductions
• ASPIRE Quality Team
– Allison Janda, MD – MPOG Cardiac Anesthesia Subcommittee Lead
– Michael Mathis, MD – MPOG Director of Research
– Kate Buehler, MS, RN – Clinical Program Manager
• Cardiac Anesthesiology Representatives joining us from around the US!
FLUID-01-C: Minimizing Colloid Use in Cardiac Surgery
– Definition: Percentage of cardiac cases in which colloids were not administered
intraoperatively
– Rationale: Lack of consistent evidence to suggest improved survival with the use
of colloids as compared to crystalloids in the surgical population. Because colloids
are more expensive than crystalloids, it is recommended that anesthesia providers
avoid the use of colloids in most instances.
FLUID-01-C Performance
FLUID-01-C
1 vote per site
Continue as is / modify / retire
Need > 50% to retire measure
Coordinating center will review all votes after meeting to
ensure no duplication
Measure Review Process
• Review literature for given measure
topic and provide review using
MPOG Measure Review Template
• Present review of literature and
recommendations at Cardiac
Subcommittee meetings
• Reviewers names will be added to
measure specifications as well as
MPOG Measure Reviewer website
Upcoming Cardiac-Focused Measure Reviews
Measure Review Date Reviewers
TEMP-06-C: Hypothermia Avoidance February 2025 Mariya Geube, Cleveland Clinic
TEMP-07-C: Hyperthermia Avoidance February 2025 Ashan Grewal, UMaryland
GLU-06: Hyperglycemia Management June 2026 Josh Billings, Vanderbilt
GLU-07: Hypoglycemia Management June 2026 Rob Schonberger, Yale
GLU-08: Hyperglycemia Treatment June 2026 Josh Billings, Vanderbilt
Thank you in advance for ensuring MPOG Cardiac-specific measures remain relevant &
consistent with published recommendations!
Contact Allison with any questions: ajanda@med.umich.edu
Transfusion Measure Discussion
Background
• Transfusion measures were due for review in May 2024.
• Measure reviews performed by assigned Quality Champions & Coordinating Center
and presented to Quality Committee
– Jacek Cywinski, MD (Cleveland Clinic) Transfusion Management Vigilance measure review: TRAN-01
– Linda Liu, MD (UCSF) Overtransfusion measure review: TRAN-02
• Quality Committee requested Cardiac Subcommittee review transfusion measure
exclusion of cardiac cases and determine if:
– Only open cardiac cases should be excluded rather than all cardiac cases or,
– Would separate measure(s) for patient blood management in the cardiac population be
appropriate?
TRAN-01: Transfusion Management Vigilance
TRAN-01: Percentage of adult patients receiving a blood transfusion with documented hemoglobin or
hematocrit value prior to administration.
● Exclusions:
○ Age <18 years
○ ASA 5 & 6
○ Postpartum hemorrhage cases
○ Massive blood loss with EBL > 2000mL and/or 4 or more units of blood transfused
○ Labor Epidurals
○ Burn Cases
○ Cardiac Cases
● Success: Documentation of hemoglobin or hematocrit within 90 minutes prior to transfusion*
*See spec for exceptions.
TRAN-02: Overtransfusion
TRAN-02: Percentage of adult patients with a post transfusion hemoglobin or hematocrit value greater
than or equal to 10 g/dL or 30%.
● Exclusions:
○ Age < 18 years
○ ASA 5 & 6
○ Postpartum hemorrhage cases
○ Massive blood loss with EBL > 2000mL and/or 4 or more units of blood transfused
○ Labor epidurals
○ Burn cases
○ Cardiac cases
● Success: Hematocrit value documented as < 30% and/or hemoglobin as < 10 g/dL or,
No hematocrit or hemoglobin checked within 18 hours of Anesthesia End
Discussion
• Maintain exclusion of cardiac cases for TRAN-01 and TRAN-02?
• Create new patient blood management measures for the open cardiac population?
• Include specific cardiac procedures in TRAN-01/TRAN-02 measures but continue to
exclude open cardiac procedures?
TRAN-01
1 vote per site
Vote:
a) Continue measure as is
b) Modify to include cardiac cases (some or all)
c) Create new cardiac specific PBM measure
Coordinating center will review all votes after meeting to
ensure no duplication
TRAN-02
1 vote per site
Vote:
a) Continue measure as is
b) Modify to include cardiac cases (some or all)
c) Create new cardiac specific PBM measure for
overtransfusion
Coordinating center will review all votes after meeting to
ensure no duplication
Antibiotic Selection Measure
ABX-04 Antibiotic Selection for Open Cardiac Procedures
• Description:
– Percentage of adult patients undergoing open cardiac surgery with an appropriate
antibiotic administered for surgical site infection prophylaxis.
• Timing:
– 120 minutes prior to Anesthesia Start through Anesthesia End
• Attribution:
– All anesthesia providers signed in at the time of Anesthesia Start Time
ABX-04 Antibiotic Selection Considerations
• Inclusions:
– Adult patients undergoing open cardiac surgical procedures
• Exclusions:
– ASA 6 or Organ Procurement (CPT: 01990)
– Non-cardiac cases as defined as those cases not meeting criteria for the cardiac case
type phenotype
– Within the general cardiac case type phenotype, exclude: Transcatheter/Endovascular,
EP/Cath groups and Other Cardiac
– Cases with age <18
– Patients already on scheduled antibiotics or had a documented infection prior to
surgery, as specified by “Patient on Scheduled Antibiotics/Documented Infection”
(value: 2) of the ABX Notes Phenotype
ABX-04 Antibiotic Selection Considerations
• Acceptable antibiotics:
– Vancomycin + Cephalosporin
– Vancomycin + Aminoglycoside
– Cephalosporin Only
• Cases will be assigned one of the following result reasons:
– Passed - Appropriate Antibiotics Administered
– Flagged - Non-standard antibiotic selection
– Flagged - Prophylactic not antibiotic administered (Not documented in MAR)
– Flagged - Antibiotic not ordered/indicated per surgeon
– Flagged - Incision/procedure start time documented: No
– Flagged - Not administered for medical reasons
– Excluded - Scheduled antibiotics/documented infection
ABX-04 Antibiotic Selection Questions
• Is the list of acceptable antibiotics complete?
– Vancomycin + Cephalosporin
– Vancomycin + Aminoglycoside
– Cephalosporin Only
• Add additional PCN allergy considerations?
– Vancomycin + Clindamycin
– Vancomycin + Fluoroquinolone
– Vancomycin + Aztreonam
ABX-04 Preliminary Performance
ABX-05 Composite Antibiotic Compliance for Open Cardiac
• Description:
– Percentage of adult patients undergoing open cardiac surgery with appropriate
antibiotic selection, timing, and re-dosing administered for surgical site infection
prophylaxis.
• Timing:
– 120 minutes prior to Anesthesia Start Time through Anesthesia End Time
• Attribution: Departmental Only
– Case level attribution, viewable on the dashboard at the case level, not provided
to individual clinicians
• Success:
– Case is passed for all open cardiac antibiotic measures (timing, re-dosing,
selection)
ABX-05 Composite Antibiotic Compliance Considerations
• Inclusions:
– Adult patients undergoing open cardiac surgical procedures
• Exclusions:
– ASA 6 or Organ Procurement (CPT: 01990)
– Non-cardiac cases as defined as those cases not meeting criteria for the cardiac case
type phenotype
– Within the general cardiac case type phenotype, exclude: Transcatheter/Endovascular,
EP/Cath groups and Other Cardiac
– Cases with age <18
– Patients already on scheduled antibiotics or had a documented infection prior to
surgery, as specified by “Patient on Scheduled Antibiotics/Documented Infection”
(value: 2) of the ABX Notes Phenotype
ABX-05-C Preliminary Performance
ABX-02-C Dashboard Performance (antibiotic timing)
ABX-03-C Dashboard Performance (antibiotic redosing)
Acute Kidney Injury - Open Cardiac Surgery
Measure Proposal
AKI-02-C: Acute Kidney Injury in patients undergoing Open Cardiac Surgery
Description: Percentage of patients undergoing an open cardiac procedure with a baseline
creatinine increase of more than 1.5 times within 7 postoperative days or the baseline
creatinine level increases by ≥ 0.3 mg/dL within 48 hours postoperatively.
Inclusion: Adult patients undergoing open cardiac surgical procedures (determined by
Procedure Type: Cardiac value code: 1)
Success:
1. The creatinine level does not go above 1.5x the baseline creatinine within 7 days post-op
2. The creatinine level does not increase by ≥ 0.3 mg/dL obtained within 48 hours after anesthesia end.
AKI-02-C: Acute Kidney Injury in patients undergoing Open Cardiac Surgery
Exclusions:
● ASA 6 (including CPT:01990)
● Cases where a baseline creatinine is not available within 60 days preoperatively
● Cases where a creatinine lab is not available within 7 postoperative days.
● Patients with more than one case in a 7-day period. The first case will be excluded if a postop creatinine is
not documented for that first case. For example, a patient that has surgery twice in a 7-day period, the
first surgery is excluded if a creatinine is not drawn in between cases
● Patients with pre-existing renal (stage 4 or 5) failure based upon BSA-Indexed EGFR < 30 mL/min/1.73m^2
determined by Preop EGFR (most recent) or MPOG Complication - Acute Kidney Injury value code -2.
● Open cardiac procedures performed in conjunction with procedures affecting the kidney, bladder, or
ureter (specific anesthesia and surgical CPT codes).
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 2024 Meeting Schedule
– September 2024
– December 2024
• Thank you for using the forum for discussion between meetings
