MPOG Cardiac Anesthesia Subcommittee Meeting
December 16th, 2024
Agenda
• Introduction & announcements
• Unblinded Review of measures:
– ABX-02-C
– ABX-03-C
– ABX-04-C
– ABX-05-C
– AKI-02-C
• Summary and next steps
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!
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-C: Hyperglycemia Management June 2026 Josh Billings, Vanderbilt
GLU-07-C: Hypoglycemia Management June 2026 Rob Schonberger, Yale
GLU-08-C: 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
Unblinded Data Review:
Antibiotic Compliance Measures
Reminders:
Per the terms and conditions outlined during the registration process:
– A culture of openness and trust are critical to the development of such a collaborative effort to improve
quality; and a commitment for confidentiality is required to further the goals of ASPIRE.
– The following examples are to be considered privileged and confidential information and should be
discussed only within the confines of the Cardiac Subcommittee Meeting.
– Any and all patient information.
– Any and all patient identifiers/information which are considered privileged and protected health
information as defined by current HIPAA laws.
– Any specific MPOG QI registry case information.
– Any information discussed regarding a specific site outcome.
– Any reference to a specific MPOG site result or analysis.
– All anesthesiology data presented including but not limited to outcome reports.
– Taking screenshots, pictures or videos of data slides is prohibited.
Site Participation
• All sites that perform >75 open cardiac procedures annually are presented on the
slides to follow
• This is a closed meeting: registration required to receive the Zoom link.
• Only those sites who have a participant on the cardiac subcommittee are unblinded
• Cardiac Anesthesia Champions were notified that unblinded data would be shared and
were given the opportunity to opt out
• No sites emailed us to express a desire to be excluded from this review
ABX-02 Antibiotic Timing, Open Cardiac
• Description:
– Percentage of adult patients undergoing open cardiac surgery with antibiotic
administration initiated within the appropriate time frame before incision (see
specification for timing expectations per agent)
• Timing:
– 120 minutes prior to Surgery Start through Surgery Start.
• Success Criteria:
– Documentation of antibiotics administered before surgery start time
ABX-02 Antibiotic Timing Considerations
• Inclusions:
– Adult patients undergoing open cardiac surgical procedures (determined by Procedure
Type Cardiac: value code 1)
• Exclusions:
– Age < 18 years
– ASA 6 including Organ Procurement
– Patients already on scheduled antibiotics or had a documented infection prior to
surgery, as determined by ABX Notes Phenotype (value code 2)
– Non-cardiac, Transcatheter/Endovascular, EP/Cath groups and Other Cardiac cases as
determined by the Procedure Type: Cardiac phenotype
– Procedure Type: Lung Transplant
Unblinded data removed from slides published to website.
Unblinded data removed from slides published to website.
ABX-03 Antibiotic Re-dosing, Open Cardiac
• Description:
– Percentage of adult patients undergoing open cardiac procedure with an antibiotic
re-dose initiated within 3-4 hours after initial antibiotic administration
(cephalosporins only).
• Timing:
– 120 minutes prior to Anesthesia Start through Surgery End. If Surgery End is not
available, then Anesthesia End.
• Success:
– Documentation of cephalosporin re-dose within 165-255 minutes after each
cephalosporin administration (max: 3 doses)
ABX-03 Antibiotic Re-dosing Considerations
• Inclusions:
– Adult patients undergoing open cardiac surgical procedures (determined by Procedure
Type Cardiac: value code 1) and receiving antibiotic prophylaxis with a cephalosporin
• Exclusions:
– Age < 18 years
– ASA 6 including Organ Procurement
– Cases where Surgery End time is before re-dose (less than 4 hours and 15 minutes after
cephalosporin dose)
– Cases without administration of a cephalosporin for antibiotic prophylaxis
– Patients already on scheduled antibiotics or had a documented infection prior to
surgery, as determined by ABX Notes Phenotype (value code 2)
– Non-cardiac, Transcatheter/Endovascular, EP/Cath groups and Other Cardiac cases as
determined by the Procedure Type: Cardiac phenotype
– Procedure Type: Lung Transplant
ABX-03-C: Antibiotic Redosing, Open Cardiac Procedures
• Attribution:
– All anesthesia providers signed in at the time of each re-dose (if not given: 255
minutes after initial cephalosporin dose, and/or if not given: 255 minutes after the
first re-dose)
• Notes:
– Ceftriaxone & cefotetan are excluded due to extended half-lives as compared to
more commonly used cephalosporins. Redosing not recommended.
– Cefoxitin excluded: non-standard antibiotic for cardiac cases with short half-life.
• Recent Updates:
– Infusions now considered (start time determines re-dose window). If still
running at time of re-dose = pass.
– If re-dosed within 255 minutes before surgery end = pass, if not = exclude.
Unblinded data removed from slides published to website.
Unblinded data removed from slides published to website.
Unblinded data removed from slides published to website.
ABX-03-C Discussion
• Some cases are re-dosed just prior to surgical incision in an effort to achieve optimal
blood concentration levels at time of incision. These cases flag as ‘Re-dosed too early’
currently. Is this appropriate?
2:49:00 PM CEFUROXIME 1.5 GM
3:10:00 PM Anesthesia Start
3:50:00 PM CEFUROXIME 1.5 GM Flagged: Re-dose too early
4:50:00 PM Procedure Start
7:51:00 PM CEFUROXIME 1.5 GM
8:48:00 PM Procedure End
9:02:00 PM Anesthesia End
• If there are multiple doses prior to incision (procedure start), should we only consider
the most recent dose and ignore earlier doses?
ABX-04 Antibiotic Selection, Open Cardiac Procedures
• Description:
– Percentage of adult patients undergoing open cardiac surgery with the
recommended antibiotic agents 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:
– Age < 18 years
– ASA 6 including Organ Procurement
– Patients already on scheduled antibiotics or had a documented infection prior to
surgery, as determined by “Patient on Scheduled Antibiotics/Documented Infection”
(value: 2) of the ABX Notes Phenotype
– Non-cardiac, Transcatheter/Endovascular, EP/Cath groups and Other Cardiac cases as
determined by the Procedure Type: Cardiac phenotype
– Lung Transplant cases as determined by the Procedure Type: Lung Transplant
phenotype
ABX-04 Antibiotic Selection Considerations
• Acceptable antibiotic combinations for Open Cardiac Procedures:
– Vancomycin + Cephalosporin
– Vancomycin + Aminoglycoside
– Cephalosporin Only
ABX-04 Antibiotic Selection Considerations
Cases will be assigned one of the following result reasons:
– Passed - Vancomycin + Cephalosporin
– Passed - Vancomycin + Aminoglycoside
– Passed - Cephalosporin Only
– Flagged - Non-standard antibiotic selection
– Flagged - Prophylactic antibiotic not administered (Not documented in MAR)
– Flagged - Antibiotic not ordered/indicated per surgeon
– Flagged - Not administered for medical reasons
– Excluded - Scheduled antibiotics/documented infection
Unblinded data removed from slides published to website.
ABX-04-C Discussion
• Should vancomycin + ‘any antibiotic with gram negative’ coverage = pass?
– Ex. Currently, vanco + Zosyn or vanco + aztreonam are flagged
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 must pass all antibiotic prophylaxis measures for which the case is not excluded for
open cardiac procedure measures (must be included in at least one ABX measure to be a
candidate for the composite measure)
– ABX-02-C / ABX-03-C / ABX-04-C
ABX-05 Composite Antibiotic Compliance Considerations
• Inclusions:
– Adult patients undergoing open cardiac surgical procedures
• Exclusions:
– Age < 18 years
– ASA 6 including Organ Procurement
– Patients already on scheduled antibiotics or had a documented infection prior to
surgery, as determined by “Patient on Scheduled Antibiotics/Documented Infection”
(value: 2) of the ABX Notes Phenotype
– Non-cardiac, Transcatheter/Endovascular, EP/Cath groups and Other Cardiac cases as
determined by the Procedure Type: Cardiac phenotype
– Lung Transplant cases as determined by the Procedure Type: Lung Transplant
Phenotype
ABX-05-C - Other Measure Build Details
Cases will be assigned one of the following result reasons:
– Passed - Antibiotic Prophylaxis Standards Met
– Flagged - Timing, Re-dosing, & Selection Not Met (ABX-02-C, ABX-03-C, & ABX-04-C
flagged)
– Flagged - Timing & Selection Not Met (ABX-02-C & ABX-04-C flagged)
– Flagged - Re-dosing & Selection Not Met (ABX-03-C & ABX-04-C flagged)
– Flagged - Timing & Re-dosing Not Met (ABX-02-C & ABX-03-C flagged)
– Flagged - Antibiotic not administered on time (ABX-02-C flagged)
– Flagged - Antibiotic not appropriately re-dosed (ABX-03-C flagged)
– Flagged - Non-standard antibiotics selection (ABX-04-C flagged)
– Excluded - Scheduled antibiotics/documented infection
*Case must be included and passed for at least one of the antibiotic measures to be
included for ABX-05. If any measure is flagged, ABX-05 will also be flagged.
Unblinded data removed from slides published to website.
8243
19651
Unblinded data removed from slides published to website.
Acute Kidney Injury - Open Cardiac Surgery
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.
Reported as an inverse measure.
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 (see spec for specific anesthesia and surgical CPT codes).
● Liver Transplants
Unblinded data removed from slides published to website.
Unblinded data removed from slides published to website.
