Dear MPOG Community,

Thank you for reading our MPOG Fall 2024 Newsletter! We are excited to give you an update on some of the exciting developments within MPOG over the past few months. 

Please join us either in person or virtually at the MPOG Retreat on Friday, October 18, 2024, occurring in conjunction with the ASA Annual Meeting in Philadelphia, Pennsylvania. We look forward to seeing some of you in person! 

We would like to extend a warm welcome to the new MPOG sites that have joined since our last newsletter: University Health Network in Toronto, Canada (our first Canadian site!) and Mass Eye and Ear in Boston, MA, and our new MPOG Executive Board Members. Additionally, applications for the 2025-2026 class of MPOG Fellows are open through November 22, 2024. 

Thank you for your continued support and commitment to MPOG and advancing the quality of and evidence informing the perioperative care of our patients. We are excited to share the updates in this Newsletter outlining this progress and we look forward to the year ahead! 

Sincerely, 

Allison Janda, MD 

MPOG Cardiac Anesthesia Quality Subcommittee Chair 

2024 MPOG Retreat registration is still open. Please join us (in person or virtually)!   

Friday, October 18, 2024  

Warwick Hotel Rittenhouse Square 

We are excited to welcome Drs. Joseph Cravero, Cynthia Lien, and Danny Muehlschlegel to their three-year term and Dr. G. Burkhard Mackensen to a two-year term starting January 2025. The Executive Board is comprised of department chairs of active MPOG sites and are elected by a vote of the MPOG department chairs.  

Please see our website for a complete list of executive board members. 

Please join us in welcoming the University Health Network in Toronto, Canada (our first Canadian site!) and Massachusetts Eye and Ear in Boston, MA to MPOG!

We were delighted to have Dr. Morgan Brown from Boston Children’s hospital, Dr. Roya Saffary from Stanford University, and Dr. Matthew Price from Corewell Health as our featured members so far this year.  

Read more about them on our Featured Member page. 



THRIVE is now enrolling patients at 18 sites with two more sites coming online soon. Over 2,700 patients have been enrolled and randomized. We are beyond thrilled with the progress of this study and invite THRIVE investigators and staff from all participating sites to join us in person at the THRIVE Site Investigators Meeting following our Annual MPOG Retreat in Philadelphia, Pennsylvania on Friday, October 18, 2024 from 3:30-6pm. All THRIVE Site PIs, co-PIs, co-Is, and coordinators are welcome, please register (no cost) on Eventbrite.

The Precision Feedback Trial, an NIH R01 funded study designed to analyze the effects of adding an algorithmically generated “precision” message to the current MPOG Provider Feedback email, is in its final month. The study team (PI Zach Landis Lewis et al.) is grateful to all 46 sites included in the intervention and control groups. Next steps for the team include analyzing trial results and preparing a manuscript for submission.  

VEGA-2 is a multicenter pragmatic cluster cross-over randomized trial to study the superior choice of vasopressor in preventing postoperative acute kidney injury after major non-cardiac surgery. This study, led by UCSF and U of M, is officially funded and site recruitment is underway. For any questions, please contact Dr. Matthieu Legrand, Dr. Allison Janda, and Dr. Sachin Kheterpal. 

Welcome to MPOG’s newest Perioperative Clinical Research Committee (PCRC) moderators and a big thank you to everyone who continues to serve on the PCRC Moderator Committee! 

McLaughlin CS, Samant A, Templeton TW, et al. Bronchial Blocker Versus Endobronchial Intubation in Young Children Undergoing One-Lung Ventilation: A Multicenter Retrospective Cohort Study. Anesth Analg. Sept 12, 2024. Online ahead of print  

Douville NJ, Smolkin ME, Blank RS, et al. Association between inspired oxygen fraction and development of postoperative pulmonary complications in thoracic surgery: a multicentre retrospective cohort study. Br J Anaesth. Sept 11, 2024. S0007-0912(24):00470-7 

Billings 4th FT, McIlroy DR, Kheterpal S, et al. Determinants and practice variability of oxygen administration during surgery in the U.S., a retrospective cohort study. Anesthesiology. September 1, 2024. 141(3):511-523 

Fisher C, Janda AM, Schonberger RB, et al. Opioid Dose Variation in Cardiac Surgery: A Multicenter Study of Practice. Anesth Analg. Aug 21, 2024. Online ahead of print 

Griffee MJ, Leis AM, Riegger LQ, et al. Intraoperative hypoglycemia among adults with intraoperative glucose measurements: a cross-sectional multicentre retrospective cohort study. Can J Aneaesth. Aug 13, 2024. Online ahead of print 

Lele AV, Vail EA, Mathis MR, et al. Identifying Variation in Intraoperative Management of Brain-Dead Organ Donors and Opportunities for Improvement: A Multicenter Perioperative Outcomes Group Analysis. Anesth Analg. Jul 25, 2024. Online ahead of print  

Chauhan MZ, Soliman MK, Sallam AB, et al. Anesthesia Techniques for Vitreoretinal Surgery in the United States: A Report from the Multicenter Perioperative Outcomes Group Research Consortium. Am J Opthalmol. Jun 12, 2024. Online ahead of print 

Savadjian AJ, Taicher BM, Mamoun N, et al. Reduce intraoperative albumin utilisation in cardiac surgical patients: a quality improvement initiative. BMJ Open Qual. Apr 24, 2024. 13(2):e002726 

Naik BI, Lele AV, Dunn LK, et al. Variability in Intraoperative Opioid and Nonopioid Utilization During Intracranial Surgery: A Multicenter, Retrospective Cohort Study. J Neurosurg Anestheiol. Mar 28, 2024. Online ahead of print 

Bao X, Kumar SS, Maheshwari K, et al. AcumenTM hypotension prediction index guidance for prevention and treatment of hypotension in noncardiac surgery: a prospective, single-arm, multicenter trial. Perioper Med (Lond). Mar 4, 2024. 13(1):13 

Andrew BY, Holms R, Taicher BM, Habib AS. The Association of Guideline-Directed Prophylaxis With Postoperative Nausea and Vomiting in Adult Patients: A Single-Center, Retrospective Cohort Study. Anesth Analg. Jan 31, 2024. Online ahead of print 

Burns ML, Hilliard P, Bicket MC, et al. Variation in Intraoperative Opioid Administration by Patient, Clinician, and Hospital Contribution. JAMA Netw Open. Jan 2, 2024. 7(1):e2351689  

NMB-05: This is a new informational measure that assesses quantitative neuromuscular monitoring use and was released in March 2024. NMB-05 calculates the percentage of cases with documentation of train-of-four count or ratio provided by a quantitative monitor (acceleromyography, electromyography, kinemyography, or mechanomyography).  

As part of MPOGs measure review process, the following measures are now retired after recommendation by the MPOG Quality Committee: 

• GLU-02: Hypoglycemia Management, Intraop (<60mg/dl) – updated version available as GLU-12 
• GLU-04: Hypoglycemia Management, Periop (<60mg/dl) – updated version available as GLU-13 
• GLU-05: Hyperglycemia Treatment, Periop (>200mg/dl) – updated version available as GLU-11 
• PONV-02-Peds: Postoperative Nausea & Vomiting Prophylaxis (Pediatric) – updated version available as PONV-04-Peds 
• MED-01: Avoiding Medication Overdose – updated version available as PAIN-03 
• PUL-02: Protective Tidal Volume (<8mL/kg PBW) – subset of PUL-01 cases, graph displaying PUL-02 performance now available on PUL-01 measure summary page within the QI Reporting Tool 
• GLU-01: Hyperglycemia Management, Intraop (>200mg/dl) – updated version available as GLU-09 
• GLU-03: Hyperglycemia Treatment, Periop (>200 mg/dl) – updated version available as GLU-10 
• PONV-01: PONV Prophylaxis: Adult (Old) will be retired October 1st. 

TRAN 01 and TRAN 02: After approval by the Cardiac Subcommittee and MPOG Quality Committee, cardiac cases are now included in the adult transfusion management measures. Additionally, these measures will not include autologous units for these cardiac cases, i.e. the measure does not assess if a hemoglobin or hematocrit is checked prior to transfusion of autologous units for TRAN-01 or if a hemoglobin or hematocrit is > 10/30 after autologous unit transfusion for TRAN-02. Cardiac cases with only autologous units administered are excluded from these measures. See measure specifications (linked below) for more details: 

• TRAN 01: Percentage of adult patients receiving a blood transfusion with documented hemoglobin or hematocrit value prior to administration 
• TRAN 02: Percentage of adult patients with a post transfusion hemoglobin or hematocrit value greater than or equal to 10 g/dL or 30%, as a proxy for overtransfusion 

The subcommittee met in June and September. Meeting minutes can be reviewed on our website. Over the summer, a measure to assess acute kidney injury in patients undergoing cardiac surgery (AKI-02-C) was released. In addition, the subcommittee has focused on developing measures to guide antibiotic prophylaxis administration for the prevention of surgical site infections. There are four measures are now available for monitoring performance in this area: 

• ABX-02-C: Antibiotic Timing for Open Cardiac Procedures 
• ABX-03-C: Antibiotic Redosing for Open Cardiac Procedures 
• ABX-04-C: Antibiotic Selection for Open Cardiac Procedures 
• ABX-05-C: Antibiotic Prophylaxis Compliance for Open Cardiac Procedures (Composite Measure) 

The next Cardiac Anesthesia Subcommittee meeting in December will offer an unblinded review session to discuss site performance on the new antibiotic administration and AKI measures. Registration will be required - please contact Dr. Allison Janda if interested in participating! 

Congratulations to Dr. Wandana Joshi on her new role as Vice-Chair of the MPOG Obstetric Anesthesia Subcommittee!

The subcommittee held meetings in May and September this year, focusing on reviewing existing obstetric-specific measures and finalizing the specification for a new measure assessing azithromycin use (ABX-06-OB). At the September meeting, Obstetric Subcommittee Chair Dr. Brandon Togioka proposed several potential future MPOG obstetric measures to align with the Society of Anesthesia and Perinatology (SOAP) Centers of Excellence measures. Meeting minutes and recordings are available on the website. 

We are excited to see ongoing interest in the subcommittee and look forward to our next meeting on Wednesday, December 4, 2024, at 1 PM EST. The agenda will include discussions on a new measure for tranexamic acid administration for cesarean deliveries with blood loss over 1000 mL, as well as updates for the new phenotype to identify patients who are pregnant at the time of surgery. 

The Obstetric Anesthesia Subcommittee is open to all providers interested in improving obstetric care. Please contact Nicole Barrios if interested in joining. 

At the Spring pediatric subcommittee meeting, Dr. Vikas O’Reilly-Shah discussed how MPOG quality metrics are used at Seattle Children’s to provide departmental feedback and promote a non-punitive culture. Dr. Nirav Shah, MPOG QI Director, presented unblinded performance data on pediatric sustainability measures, highlighting variability in performance across institutions. Discussions focused on the impact of default ventilator settings, provider education, and gas flow rate biases, with shared insights on cost savings and the challenges of nitrous oxide usage. 



We are hosting a pediatric QI interest group meeting immediately following the MPOG Retreat in Philadelphia on Friday, October 18, 2024 from 3-4pm EST. Discussions will focus on pediatric quality metrics that span the entire perioperative phase. 

Our next subcommittee meetings will be held on November 4, 2024  

• Pediatric Cardiac Meeting (3:30 - 4pm EST) 
• Pediatric General Meeting (4 - 5pm EST) - review and vote on the pediatric PONV prophylaxis measure: PONV-04-Peds.  

The pediatric meetings are open to anyone interested in improving pediatric anesthesia care, regardless of MPOG membership status. Please contact Meridith Wade if interested in joining the subcommittee.