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Measure Information Form
Version 2010B

Measure Information Form

Measure Set: Surgical Care Improvement Project (SCIP)

Set Measure ID: SCIP-Inf-7

Performance Measure Name: Colorectal Surgery Patients with Immediate Postoperative Normothermia

Description: Colorectal surgery patients with immediate normothermia (greater than or equal to 96.8° F) within the first fifteen minutes after leaving the operating room.

Rationale: Core temperatures outside the normal range pose a risk in all patients undergoing surgery.

According to the Clinical Guidelines for the Prevention of Unplanned Perioperative Hypothermia by the American Society of PeriAnesthesia Nurses (ASPAN, 2001), published research has correlated impaired wound healing, adverse cardiac events, altered drug metabolism, and coagulopathies with unplanned perioperative hypothermia. A study by Kurtz, et al (1996), found that incidence of culture-positive surgical site infections among those with mild perioperative hypothermia was three times higher than the normothermic perioperative patients. In this study, mild perioperative hypothermia was associated with delayed wound closure and prolonged hospitalization. In a meta-analysis of outcomes and costs, Mahoney and Odom (1999), demonstrated that hypothermia is associated with a significant increase in adverse outcomes, including an increased incidence of infections. The authors also concluded that hypothermia is associated with an increased chance of blood products administration, myocardial infarction, and mechanical ventilation. These adverse outcomes resulted in prolonged hospital stays and increased healthcare expenditures.

Type of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Surgery patients whose first recorded temperature was greater than or equal to 96.8Ί F within the first fifteen minutes after leaving the operating room.

Included Populations: Not applicable

Excluded Populations: None

Data Elements:

Denominator Statement: All selected colorectal surgery patients with no evidence of prior infection.

Included Populations:
  • An ICD-9-CM Principal Procedure Code of selected surgeries (as defined in Appendix A, Table 5.10 for ICD-9-CM codes).
  • An ICD-9-CM Principal Procedure Code of selected surgeries (as defined in Appendix A, Table 5.12 for ICD-9-CM codes).

Excluded Populations:

  • Patients less than 18 years of age
  • Patients who have a length of Stay >120 days
  • Patients who had a principal diagnosis suggestive of preoperative infectious diseases (as defined in Appendix A, Table 5.09 for ICD-9-CM codes)
  • Burn patients (as defined in Appendix A, Table 5.14 for ICD-9-CM codes)
  • Patients whose ICD-9-CM principal procedure was performed entirely by laparoscope
  • Patients enrolled in clinical trials
  • Patients whose ICD-9-CM principal procedure occurred prior to the date of admission
  • Patients with physician/advance practice nurse/physician assistant (physician/APN/PA) documented infection prior to surgical procedure of interest
  • Patients who expired perioperatively

Data Elements:

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. Retrospective data sources for required data elements include administrative data and medical records.

Data Accuracy: Variation may exist in the assignment of ICD-9-CM codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: In analyzing any unexpected measure rates for SCIP-Inf-7, hospitals may find it useful to examine the consistency with which temperatures are documented after surgery. Inconsistent documentation will reduce the hospital's score.

Sampling: Yes. For additional information see the Sampling Section.

Data Reported As: Aggregate rate generated from count data reported as a proportion.

Selected References:

  • American Society of PeriAnesthesia Nurses. Clinical Guidelines for the prevention of unplanned perioperative hypothermia.2001 PMID: 00000F.
  • Frank SM, Raja SN, Bulaco, C, et al: Relative contributions of core and cutaneous temperature to thermal comfort and autonomic responses in humans. J Appl Physiol. 86:1588-1593,1999. PMID: 10233122.
  • Mahoney C, Odom J: Maintaining Intraoperative normothermia: a meta-analysis of outcomes with costs. AANA Journal. 67:155-164, 1999. PMID: 10488289.
  • Hooper V: Perioperative thermoregulation: A survey of clinical practices. Paper presented at the Consensus Conference on Perioperative Thermoregulation, ASPAN, Bethesda, MD, 1998. PMID: 15096446.
  • Frank SM, Beattie C, Christopherson R, et al: Epidural versus general anesthesia, ambient operating room temperature, and patient age as predictors of inadvertent hypothermia. Anesthesiology. 77:252-257, 1992. PMID: 1642343.
  • Carli F, Emery P, Freemantle C: Effect of intraoperative normothermia on postoperative protein metabolism in elderly patients undergoing hip arthroplasty. Br J Anaesth. 63:276-282,1989. PMID: 2803885.
  • Bennett J, Ramachandra V, Webster J, et al: Prevention of hypothermia during hip surgery: Effect of passive compared with active skin surface warming. Br J Anaesth. 73:180-183, 1994. PMID: 7917732.
  • Kurz A, Sessler DI, Lenhardt R: Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med. 334:1209-1215, 1996 [Accompanied by an editorial; 334:1263-1264.] PMID: 8606715.
  • Sessler DI: Current concepts: Mild intraoperative hypothermia. N Engl J Med. 336:1730-1737, 1997. PMID: 9180091.
  • Brauer A, Perl T, Uyanik Z, et al: Perioperative thermal insulation: minimally clinically important differences? Br J Anaesth. 2004 Jun;92(6):836-840. Epub 2004 Apr 19.
  • Sessler DI. A proposal for new temperature monitoring and thermal management guidelines. Anesthesiology. 1998; 89 (5):1298-1300.

Measure Algorithm:

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Related Topics

Measure Information Form SCIP-Inf-7
Specifications Manual for Joint Commission National Quality Core Measures (2010B)
Discharges 10-01-10 (4Q10) through 03-31-11 (1Q11)