Percentage of adult patients undergoing open cardiac procedures where hypotension for greater than 5 minutes (defined as MAP < 55 mmHg) was avoided during the induction period until surgery start.

Intraoperative hypotension has been consistently shown to compromise organ perfusion and substantially increase the risk of adverse postoperative outcomes, including mortality, cardiac adverse events (CAEs), acute kidney injury (AKI), and neurologic complications such as stroke. The open cardiac surgical population is particularly vulnerable, given the pre-existing cardiovascular disease, frequent comorbidities, and the complexity of cardiopulmonary bypass and anesthetic management.

Multiple large observational studies have demonstrated a strong association between decreased mean arterial pressure (MAP) and postoperative morbidity and mortality. A pivotal retrospective review conducted by Walsh et al. (2013) analyzed over 33,000 non-cardiac surgical patients and found that even brief episodes of intraoperative MAP <55 mmHg independently predicted an increased risk of CAEs and AKI.¹ These findings have been corroborated in further studies, strengthening the relationship between hypotension and adverse renal as well as cardiac outcomes.^{2, 3} While these data were initially obtained in the non-cardiac population, the implications are profound for open cardiac patients, where end-organ perfusion is even more susceptible to hemodynamic disturbances.

The challenge is particularly profound around the time of anesthetic induction, where pronounced and sometimes sudden hypotension is common. Wesselink et al. (2018) demonstrated that approximately 26% of older adults develop significant hypotension during anesthetic induction.³ This peri-induction hypotension is clinically important in cardiac surgery due to the delicate balance of myocardial supply-demand and risk of organ injury in an already critically ill cohort.

Given that hypotensive episodes are both prevalent and potentially preventable or treatable with vigilant monitoring and prompt intervention, avoidance of intraoperative hypotension is a crucial modifiable target to reduce postoperative complications in open cardiac surgery. Maintaining MAP above critical thresholds is strongly recommended to preserve organ perfusion and minimize postoperative morbidity and mortality.

Anesthesia Start to Surgery Start

Adult patients undergoing open cardiac surgical procedures (determined by Procedure Type: Cardiac value code: 1)

• Age < 18 years 
• ASA 6 including Organ Procurement (CPT:01990)
• Non-cardiac, Transcatheter/Endovascular, EP/Cath, and Other Cardiac Phenotype by the Procedure Type: Cardiac Phenotype (value codes: 0, 2, 3, and 4)
• Lung Transplants

• MAP <55mmHG that does not exceed cumulative time of 5 minutes during induction OR
• MAP ≥55mmHG throughout induction period.

In instances where there are two blood pressure monitoring methods, the higher MAP will be used to determine measure compliance. Artifact readings will be identified and removed from final measurement calculation. Artifact processing will occur according to the Blood Pressure Observations phenotype.

If measure result details, invasive blood pressure values with MAP < 55 mmHg triggering a flagged case will be labeled as ‘invasive’. Noninvasive blood pressure values with MAP < 55 mm HG triggering a flagged case will be labeled as ‘noninvasive’. If the case has both noninvasive and invasive blood pressure values with MAP < 55 mmHg during the induction period, the case will be labeled as ‘invasive’. The number of minutes of MAP < 55 mmHg during the induction time period will be resulted.

*This measure will include only valid MPOG cases as defined by the Is Valid Case phenotype.

Not Applicable

Provider(s) signed in during the measure time period.

1. Walsh, M., Devereaux, P.J., Garg, A.X., et al. (2013). Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirically based definition of hypotension. Anesthesiology, 119(3), 507-515. https://doi.org/10.1097/ALN.0b013e3182a10e26
2. Sun, L.Y., Wijeysundera, D.N., Tait, G.A.M., et al. (2015). Association of intraoperative hypotension with acute kidney injury after elective noncardiac surgery. Anesthesiology, 123(3), 515-523. https://doi.org/10.1097/ALN.0000000000000767
3. Wesselink, E.M., Kappen, T.H., Torn, H.M., Slooter, A.J.C., van Klei, W.A. (2018). Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. British Journal of Anaesthesia, 121(4), 706-721. https://doi.org/10.1016/j.bja.2018.04.036

Next Review: 2028

Published date: 08/2025