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Defining an Intraoperative Hypotension Threshold in Association with Stroke in Cardiac Surgery
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Background: The authors hypothesized that a multiparameter intraoperative decision support system with real-time visualizations may improve processes of care and outcomes.Methods: Electronic health record data were retrospectively compared over a 6-yr period across three groups: experimental cases, in which the decision support system was used for 75% or more of the case at sole discretion of the providers; parallel controls (system used 74% or less); and historical controls before system implementation. Inclusion criteria were adults under general anesthesia, advanced medical disease, case duration of 60 min or longer, and length of stay of two days or more. The process measures were avoidance of intraoperative hypotension, ventilator tidal volume greater than 10 ml/kg, and crystalloid administration (ml · kg–1 · h–1). The secondary outcome measures were myocardial injury, acute kidney injury, mortality, length of hospital stay, and encounter charges.Results: A total of 26,769 patients were evaluated: 7,954 experimental cases, 10,933 parallel controls, and 7,882 historical controls. Comparing experimental cases to parallel controls with propensity score adjustment, the data demonstrated the following medians, interquartile ranges, and effect sizes: hypotension 1 (0 to 5) versus 1 (0 to 5) min, P < 0.001, beta = –0.19; crystalloid administration 5.88 ml · kg–1 · h–1 (4.18 to 8.18) versus 6.17 (4.32 to 8.79), P < 0.001, beta = –0.03; tidal volume greater than 10 ml/kg 28% versus 37%, P < 0.001, adjusted odds ratio 0.65 (0.53 to 0.80); encounter charges $65,770 ($41,237 to $123,869) versus $69,373 ($42,101 to $132,817), P < 0.001, beta = –0.003. The secondary clinical outcome measures were not significantly affected.Conclusions: The use of an intraoperative decision support system was associated with improved process measures, but not postoperative clinical outcomes.
CME Credit: 1.00 AMA PRA Category 1 Credit™
Required Hardware / Software:Adobe Acrobat Reader, Internet connection. Web browser version must have been released within the last three years.
Activity Release Date:01/16/2018
Activity Expiration Date:01/15/2021
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Learning Objectives: After successfully completing this activity, the learner will be able to:
-Recognize the limitations of the US Food and Drug Administration’s role in regulating clinical decision-support technologies (1,2)-Consider the effect of decision-support system process-of-care...
-Recognize the limitations of the US Food and Drug Administration’s role in regulating clinical decision-support technologies (1,2)-Consider the effect of decision-support system process-of-care measure selection and utilization (3,4)-Discuss the effect of decision-support system utilization on outcome measures (5,6).
Faculty and Credentials
Editor-in-Chief: Evan D. Kharasch, M.D., Ph.D., has reported receiving consulting fees from TEN Healthcare.
CME Editors: Leslie C. Jameson, M.D. has reported no relevant financial relationships with commercial interests. Dan J. Kopacz, M.D., has reported holding an equity position with SoloDex, LLC.
Authors: Kevin K. Tremper, Ph.D., M.D., reported founding and owning equity in AlertWatch. Sachin Kheterpal, M.D., M.B.A., and Amy Shanks, Ph.D., report no relevant financial relationships with commercial interests. Gail H. Javitt, J.D., M.P.H., reports no relevant financial relationships with commercial interests.
ASA Staff: Kari L. Lee, Senior Managing Editor, has reported no relevant financial relationships with commercial interests. Ginger Clark, Senior Editor, has an equity position in Merck & Co.
Disclosure Statement: The American Society of Anesthesiologists remains strongly committed to providing the best available evidence-based clinical information to participants of this educational activity and requires an open disclosure of any potential conflict of interest identified by our faculty members. It is not the intent of the American Society of Anesthesiologists to eliminate all situations of potential conflict of interest, but rather to enable those who are working with the American Society of Anesthesiologists to recognize situations that may be subject to question by others. All disclosed conflicts of interest are reviewed by the educational activity course director/chair to ensure that such situations are properly evaluated and, if necessary, resolved. The American Society of Anesthesiologists educational standards pertaining to conflict of interest are intended to maintain the professional autonomy of the clinical experts inherent in promoting a balanced presentation of science. Through our review process, all American Society of Anesthesiologists CME activities are ensured of independent, objective, scientifically balanced presentations of information. Disclosure of any or no relationships will be made available for all educational activities.
Disclaimer: The information provided at this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.
Core Competencies: Medical knowledge
Target Audience: ANESTHESIOLOGY Journal CME is intended for anesthesiologists. Researchers and other health care professionals with an interest in anesthesiology may also participate.
The American Society of Anesthesiologists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The American Society of Anesthesiologists designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should
claim only the credit commensurate with the extent of their participation in the activity.
1.00 Non-physician Credit Non-physicians may receive a Certificate of Completion stating that this activity was designated for 1.00 AMA PRA Category 1 Credit(s)™.
Activity Release Date: 1/16/2018 Activity Expiration Date: 1/15/2021
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