MPOG Pediatric Committee Meeting
June 1, 2026
Agenda
Announcements
New Measure Update: TRAN-06-Peds
Measure Review: Intraoperative Normothermia (TEMP-04-Peds)
Dr. Lauren Madoff, Boston Children's
Measure Review: Multimodal Analgesia (PAIN-01-Peds)
Dr. Morgan Brown, Boston Children's
Membership Update: 32 Pediatric Hospitals in MPOG
2026 Pediatric
Meetings
Pediatric Committee Meetings
• March 1
• June 1
• October 16 (in-person at MPOG Retreat)
Pediatric Cardiac Workgroup
● September (Virtual)
Pediatric Blood Management
TRAN-06-Peds: Preop Anemia
Patient Blood Management
(1) screening for, diagnosing, and appropriately treating anemia
(2) minimizing surgical, procedural, and iatrogenic blood losses
(3) managing coagulopathic bleeding to improve patient outcomes through patient-centered
care.
– Goobie, Faroni 2025 Perioperative paediatric patient blood management: a narrative review
• Process Metric
% of cases where a patient had preoperative anemia
Interest in specific case types
• Major non-cardiac cases who are at risk of possible blood transfusion
Proposed Metric: TRAN-06-Peds
Description:
Percentage of pediatric patients undergoing
elective major noncardiac surgery who were
anemic preoperatively.
Inclusions:
Pediatric patients undergoing major
non-cardiac procedures. The following
anesthesia CPT codes were included:
CPT Code CPT Description Category
00210 Intracranial procedures; NOS
Neurosurgery
00215 Cranioplasty or skull fracture elevation
00216 Intracranial vascular procedures
00220 CSF shunting procedures
00300 Head/neck integumentary, muscle, nerve
Head & Neck
00320 Esophagus, thyroid, larynx, trachea (≥1 yr)
00326 Larynx/trachea (<1 yr)
00500 Esophagus procedures
00539 Tracheobronchial reconstruction
Thoracic
00540 Thoracotomy; NOS
00541 Thoracotomy w/ one lung ventilation
00790 Upper abdomen intraperitoneal; NOS
Abdominal
00792 Partial hepatectomy / liver hemorrhage
00840 Lower abdomen intraperitoneal; NOS
00862 Extraperitoneal lower abdomen (renal/urinary)
Genitourinary
00630 Lumbar spine; NOS
Spine
00670 Extensive spine/spinal cord
01210 Open hip procedures
Orthopedic
00400 Integumentary (extremities/trunk/perineum)
Soft Tissue
Proposed Metric: TRAN-06-Peds
Exclusions:
● Age > 18 years
● Neonates < 30 days (defined by Age (months) value < 1)
● ASA 6 including Organ Procurement
● Emergency procedures (defined by Emergency Status (yes/no))
● Cardiac surgery (defined by Procedure Type Cardiac (pediatric) value_codes: 1, 2)
● Anesthesia Duration < 60 minutes
● Surgery Duration < 45 minutes
● TEE/Cardioversions
● Liver transplant, Lung transplant, Kidney transplant
● Burn Debridement (CPT: 01953)
● Missing Preop Hemoglobin within 30 days of Procedure
*Overall Rate of Transfusion: 8.45%
Proposed Metric: TRAN-06-Peds
Success:
The most recent preoperative hemoglobin
value documented within 30 days of
Anesthesia Start was above the defined
anemia threshold
Provider Attribution:
None - Informational Measure Only
WHO Guidelines on haemoglobin cutoffs to define anaemia in individuals and populations (2024)
TEMP-04 Measure Review
MPOG Meeting
BCH Department of Anesthesiology
Lauren Madoff, MD
June 1, 2026
16
TEMP-04-PEDS
▪Description
▪ Percentage of pediatric patients < 18 years old who have a median core/near
core body temperature > 36C (96.8F) during the procedure.
▪Threshold
▪ 90%
▪Inclusion
▪ Pediatric patients requiring anesthesia care
▪ Precipitating circumstances or background prior to event
17
TEMP-04-PEDS
Exclusion Criteria
▪ Age ≥ 18 years
▪ ASA 5 and 6 including Organ Procurement (CPT: 01990)
▪ Cases ≤ 30 minutes duration between measure start to measure end
▪ Cases without a core or near core temperature route documented
▪ Cases where patient is hypothermic (< 35.5C) or hyperthermic ( > 38C) preoperatively (added 7/2023)
▪ MAC cases (determined by Anesthesia Technique: Sedation)
▪ Procedure Types
▪ CPB cardiac cases (determined by Procedure Type: Cardiac (peds) value codes 1 and 4)
▪ MRI only procedures
▪ Endoscopy and ERCP without another procedure (added 7/2023)
▪ Unlisted Anesthesia procedure (CPT: 01999)
▪ Labor Epidurals
18
TEMP-04 March 2023 review
▪ Background articles
▪ Hypothermia can lead to SSIs and other post-operative complications
▪ Hyperthermia can also be detrimental
▪ Pre-op temperature may also be a contributing factor
▪ Variable outcomes reported
▪ o Hyperthermia is also detrimental
▪ Discussion around median as problematic for this measure
▪ Discussed changing from median temp to a percentage of the total time
▪ Increase the time of included procedures to >60min
▪ Majority voted not to change criteria
Thank You!
PAIN-01 Measure Review
MPOG Meeting
BCH Department of Anesthesiology
Morgan Brown, MD, PhD
June 1, 2026
23
PAIN-01-PEDS
▪Description
▪ Percentage of pediatric patients < 18 years old who undergo a procedure and
receive atleast one non-opioid adjunct preoperatively or intraoperatively.
▪Threshold
▪ 90%
▪Inclusion
▪ Pediatric patients < 18y requiring anesthesia care
▪ Precipitating circumstances or background prior to event
24
PAIN-01-PEDS Review of New Literature
Olejnik L, Pedro Lima J, Sadeghirad B, et al. Pharmacologic management of acute pain in children: a systematic review and
network meta-analysis. JAMA Pediatrics. 2025;179:407-417
25
Ali S, Klassen TP, Candelaria P, et al. Acetaminophen (Paracetamol) or Opioid Analgesia Added to Ibuprofen for Children’s
Musculoskeletal Injury. Two Randomized Trials JAMA.2026;335:863-873.
26
Paterson H, Vadiveloo T, Innes K, et al.
Intravenous Lidocaine for Gut Function Recovery
in Colonic Surgery. A Randomized Clinical Trial.
JAMA. 2025:333:39-48.
27
Hua X, Zhang R, Xie H, et al.
Preemptive acetaminophen for
postoperative analgesia in children
undergoing surgery: a systematic
review and meta-analysis. Pain
Physician. 2025;38:E359-369.
28
Literature Review cont.
▪ Poor adherence despite protocolized order sets in the EHR.
▪ Preoperative analgesics were given in only 33% of cases and regional blocks in 44%.
▪ In patients who received at least 13 of the components, there was a significant
reduction in LOS and complications.
Raval MV, Tian Y, Schafer W, et al. Implementation and effectiveness of an enhanced recovery protocol
for children undergoing surgery. The ENRICH_US Stepped-Wedge Cluster Randomized Trial. JAMA
Surg 2026. Epub.
29
▪ NSAIDs appear to be the most efficacious at both reducing opioid use and need for rescue medications.
▪ Ketamine doesn’t reduce need for rescue medications.
▪ Data for dexmedetomidine is tempered by increased PACU stay and unclear benefit.
▪ New trial in adults does not suggest that IV lidocaine is helpful.
▪ Other adjuncts (magnesium, gabapentin, clonidine) do not have adequate data to support benefit in
pediatrics.
▪ Regional anesthesia does reduce opioid consumption.
▪ ERAS protocols likely work when actually implemented.
Limitations to current literature:
1. Primary outcome in most studies is opioid consumption, not pain relief or functional recovery.
2. Most studies are single agent vs. placebo, not groups of medications.
3. Studies only include some procedures: tonsillectomy, scoliosis, inguinal hernia
4. Very little data for neonates or infants
5. Little data on side-effects from polypharmacy
Summary: Multimodal analgesia is still strongly supported in principle, but the data
is only moderate at best. It is becoming more clear that not all adjuncts are equal.
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PAIN-01-PEDS Exclusion Criteria
● Age ≥ 18 years of age
● ASA 5 and 6 including Organ Procurement
● Procedure Types
○ Block only, Intubation only, ECT
○ TEE/Cardioversions
○ Endoscopy and ERCP without another procedure
○ Bronchoscopy without another procedure
○ Obstetric Procedures
○ Diagnostic Imaging Procedures
○ Open Cardiac - Suggest removing
○ Otoscopy (00124)
○ Central Line Placement (00532)
○ Lumbar Puncture (00635) or procedure text 'AN IP LP/BM' or 'AN LP/BM OUT'
○ Rooms tagged as ‘Other - offsite anesthesia’
○ Cases with procedure text ‘(Actual) ABR Testing’ (without any additional procedures
listed)
● Patients who remained intubated postoperatively
● Cases with a Spinal or Combined Spinal/Epidural given alone
● Cases with no analgesia given
31
PAIN-01-PEDS Success Criteria
At least one non-opioid adjunct (medication, local, regional block, caudal, or
epidural) was administered to the patient during the preoperative or intraoperative
period.
▪ Included adjuncts: acetaminophen, NSAIDs, ketamine, clonidine, and
dexmedetomidine.
*Dexamethasone given alone is not considered a non-opioid adjunct to prevent multiple false
positives that may skew measure performance.
▪ Systemic lidocaine administered via IV infusion is considered as an alternative
to regional anesthesia techniques.
▪ Suggest – removing IV lidocaine given recent trial in adults.
Majority of sites are achieving the benchmark - consideration for retiring as metrics should focus on
areas of variability where sites can target improvement efforts.
Emphasizes the need for an outcome based metric of pain score or rescue opioid in recovery room.
Thank You!
