Intraoperative Hypotension Among Non-Emergent Noncardiac Surgical Cases

A New QCDR Quality Measure

A new measure, implemented with reduced provider burden, that improves patient outcomes, contributes to MIPS Improvement Activities, and supports objective quality measurement and reporting.

Intraoperative Hypotension (IOH)

A quality measure designed to improve patient care & reduce costly readmissions

About the IOH Measure

ePreop, now part of Provation, and Cleveland Clinic are co-stewarding a new quality measure for anesthesia providers, titled “ePreop31: Intraoperative Hypotension Among Non-Emergent Noncardiac Surgical Cases.”

The measure seeks to encourage qualified anesthesia providers to maintain an intraoperative mean arterial pressure (MAP) above 65 mmHg in order to reduce the risk of adverse outcomes such as acute kidney injury and myocardial injury.

The measure is supported by the Anesthesia Quality Institute (AQI) and approved by Center for Medicare & Medicaid Services (CMS) as a Qualified Clinical Data Registry (QCDR) measure for the MIPS program. The AQI NACOR® database is an approved QCDR, accommodating the robust datasets of the Intraoperative Hypotension measure.

About the IOH measure
Key facts

Key Facts

  • Measures the percentage of cases in which a patient’s MAP falls below 65 mmHg for a cumulative total of total of 15 minutes or more.
  • Risk-adjusted to account for patient and case-level variability.
  • Reduced provider documentation burden—ePreop manages data collection through the hospital EHR and/or data warehouse as well as analysis, score calculations and submission.
  • Helps to support quality improvement initiatives that are meaningful to patients and surgical facilities.
  • Focused on improving patient care and outcomes.

Reasons to Participate

A Quality Measure Focused on Improving Patient Outcomes

Studies have shown a strong association between intraoperative hypotension and increased risk of acute kidney injury (AKI) and myocardial injury—the latter being a common cause of postoperative mortality within 30 days after surgery. 123

Lead Objective Quality Measurement

Early adopters of this measure will take a leadership position in helping to define a valuable measure that supports an increasing desire for objective quality measurement and reporting.

Facilitate MIPS Participation

The IOH Measure may contribute to Merit-Based Incentive Payment System (MIPS) Improvement Activities (IA) with reduced provider burden.

1  Salmasi, V., Maheshwari, K., Yang, G., Mascha, E.J., Singh, A., Sessler, D.I., & Kurz, A. (2017). Relationship between intraoperative hypotension, defined by either reduction from baseline or absolute thresholds, and acute kidney injury and myocardial injury. Anesthesiology, 126(1), 47-65.

 2 Sun, L.Y., Wijeysundera, D.N., Tait, G.A., & Beattie, W.S. (2015). Association of Intraoperative Hypotension with Acute Kidney Injury after Elective Noncardiac Surgery. Anesthesiology, 123(3), 515-523.

 3 Walsh, M., Devereaux, P.J., Garg, A.X., Kurz, A., Turan, A., Rodseth, R.N., Cywinski, J., Thabane, L., & Sessler, D.I. (2013). Relationship between Intraoperative Mean Arterial Pressure and Clinical Outcomes after Noncardiac Surgery. Anesthesiology, 119(3), 507-515.

Reduce Documentation Burden

Reduce Documentation Burden

ePreop will work directly within your facilities' EHR system to manage objective data collection and score calculation. This measure offers reduced documentation burden for participating providers and anesthesia groups.

Report On and Improve a Critical Metric

The clinical data is clear on the link between hypotension severity, duration, and outcomes.4

Intraoperative hypotension is a prevalent issue among adult noncardiac surgery patients, with 31.3% having experienced a MAP below 65 mmHg for 10 minutes or longer.5

MAPs below absolute thresholds of 65 mmHg or relative thresholds of 20% were progressively related to both myocardial and acute kidney injury. Noncardiac surgery patients are at increased risk of acute kidney and myocardial injury when their cumulative time below a MAP of 65 mmHg reaches or exceeds 13 minutes. When patients fall further below this threshold, even shorter durations are associated with increased odds.

4  Sessler, D., Bloomstone, J., Aronson, S., Berry, C., Gan, T., Kellum, J., Plumb, J., Mythen, M., Grocott, M., Edwards, M., Miller, T. (2019). Perioperative Quality initiative Consenus Statement on Intraoperative Blood Pressure, Risk and Outcome for Elective Surgery. British Journal of Anesthesia, 122 (5), 563-574.

 5 Bijker, J., van Klei, W., Kappen, T., van Wolfswinkel, L., Moons, K., Kalkman, C. (2007). Incidence of Intraoperative Hypotension as a Function of the Chosen Definition. Anesthesiology, 107(2), 213-220.

Calibrated for Real-World Use

The IOH Measure is constructed to recognize that there’s no “one size fits all” in anesthesia, or medicine. Providers are not expected to receive a score of zero on the measure, rather the measure accounts for the risk of each patient and case, and recognizes that patients' MAP may fall below 65 mmHg for reasons outside of the providers’ control.

It is also not intended to circumvent the judgment of providers who may manage individual cases with a higher or lower target MAP.

Calibrated for real-world use

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Join us and be a leader in defining a new quality measure and setting a new standard in intraoperative care.

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