Study to Determine the Impact of Intraoperative Blood Pressure Management on Postoperative Outcomes (MAP-ALIVE)

NCT ID: NCT02019342

Last Updated: 2018-01-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

WITHDRAWN

Study Classification

OBSERVATIONAL

Study Start Date

2011-06-30

Study Completion Date

2014-01-31

Brief Summary

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The purpose of this study is to determine

1. whether intraoperative hypotension or hypertension is independently associated with postoperative mortality and morbidity
2. whether quality improvement interventions implemented at the University of Michigan and at Washington University:

1. decrease the extent and duration of intraoperative hypotension and hypertension.
2. are associated with decreased postoperative mortality and morbidity.

Detailed Description

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Recent epidemiological data from an European study suggests that the 30-day postoperative mortality rate reaches a rate of about 1 in 50. A similar rate has been observed at Barnes-Jewish Hospital (BJH) according to the investigators published and unpublished data from the B-Unaware (NCT00281489) and BAG-RECALL (NCT00682825) clinical trials. Many factors are associated strongly and independently with postoperative morbidity and mortality; including patient age, functional status, comorbid medical conditions, and duration and invasiveness of the surgery. It is imperative to identify modifiable factors for possible intervention.

With the advent of electronic intraoperative medical record, intraoperative hemodynamic factors can be assessed as a potential contributor to postoperative morbidity and mortality. Recent studies have shown that intraoperative hypotension occurs commonly and is associated with both early and late postoperative mortality. The investigators goal is to conduct a study that might help to clarify whether intraoperative blood pressure management might be interdependently associated with postoperative morbidity and mortality. There are two phases in this trial: pre-quality improvement phase and post quality improvement phase. Pre-quality improvement phase data will be used as a baseline control group. Data from this phase will also be used to establish whether there appears to be an independent association between intraoperative blood pressure management and postoperative morbidity and mortality. The Anesthesiology Departments at Washington University in St. Louis and at the University of Michigan are implementing quality improvement initiatives in relation to intraoperative blood pressure management. Following implementation of the quality improvement initiatives, the investigators plan to determine whether: a) there is an improvement in intraoperative blood pressure management; b) whether there is a decrease in postoperative morbidity and mortality.

Conditions

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Death Postoperative Complications Myocardial Infarction Stroke Renal Failure

Study Design

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Observational Model Type

COHORT

Study Time Perspective

OTHER

Study Groups

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Post-quality improvement cohort

Patient cohort after FACE quality improvement initiative is implemented

FACE quality improvement initiative (see below)

Intervention Type OTHER

Feedback (F): Regular feedback to practitioners; MAP Alerts (A): Change in electronic alert systems for high and low mean arterial pressure with patient specific alerts; Checklist (C): Interactive checklist in relation to the quality improvement initiative; Education campaign (E): Education campaigns about best intraoperative management of blood pressure.

Pre-quality improvement cohort

Patient cohort prior to implementation of FACE quality improvement initiative

Pre-quality improvement initiative

Intervention Type OTHER

Patients in the pre-quality improvement initiative arm would receive current standard practice.

Interventions

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FACE quality improvement initiative (see below)

Feedback (F): Regular feedback to practitioners; MAP Alerts (A): Change in electronic alert systems for high and low mean arterial pressure with patient specific alerts; Checklist (C): Interactive checklist in relation to the quality improvement initiative; Education campaign (E): Education campaigns about best intraoperative management of blood pressure.

Intervention Type OTHER

Pre-quality improvement initiative

Patients in the pre-quality improvement initiative arm would receive current standard practice.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* All patients undergoing surgery at Barnes-Jewish Hospital or the University of Michigan between 8/1/2009 and 10/31/2012

Exclusion Criteria

* Patients undergoing organ harvest or terminal surgical procedure (American Society of Anesthesiologists physical status 6)
* Patients without a Social Security Number
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Michigan

OTHER

Sponsor Role collaborator

Washington University School of Medicine

OTHER

Sponsor Role lead

Responsible Party

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Michael Avidan

Director, Institute of Quality Improvement, Research & Informatics

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Michael S Avidan, MBBCh

Role: PRINCIPAL_INVESTIGATOR

Washington University School of Medicine

Sachin Kheterpal, MD

Role: PRINCIPAL_INVESTIGATOR

University of Michigan

Alex S Evers, MD

Role: STUDY_CHAIR

Washington University School of Medicine

Kevin Tremper, MD PhD

Role: STUDY_CHAIR

University of Michigan

Anshuman Sharma, MD

Role: STUDY_DIRECTOR

Washington University School of Medicine

Dan Helsten, MD

Role: STUDY_DIRECTOR

Washington University School of Medicine

Locations

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University of Michigan School of Medicine

Ann Arbor, Michigan, United States

Site Status

Washington University School of Medicine

St Louis, Missouri, United States

Site Status

Countries

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United States

References

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Noordzij PG, Poldermans D, Schouten O, Bax JJ, Schreiner FA, Boersma E. Postoperative mortality in The Netherlands: a population-based analysis of surgery-specific risk in adults. Anesthesiology. 2010 May;112(5):1105-15. doi: 10.1097/ALN.0b013e3181d5f95c.

Reference Type BACKGROUND
PMID: 20418691 (View on PubMed)

Kertai MD, Pal N, Palanca BJ, Lin N, Searleman SA, Zhang L, Burnside BA, Finkel KJ, Avidan MS; B-Unaware Study Group. Association of perioperative risk factors and cumulative duration of low bispectral index with intermediate-term mortality after cardiac surgery in the B-Unaware Trial. Anesthesiology. 2010 May;112(5):1116-27. doi: 10.1097/ALN.0b013e3181d5e0a3.

Reference Type BACKGROUND
PMID: 20418692 (View on PubMed)

Monk TG, Saini V, Weldon BC, Sigl JC. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg. 2005 Jan;100(1):4-10. doi: 10.1213/01.ANE.0000147519.82841.5E.

Reference Type BACKGROUND
PMID: 15616043 (View on PubMed)

Bijker JB, van Klei WA, Vergouwe Y, Eleveld DJ, van Wolfswinkel L, Moons KG, Kalkman CJ. Intraoperative hypotension and 1-year mortality after noncardiac surgery. Anesthesiology. 2009 Dec;111(6):1217-26. doi: 10.1097/ALN.0b013e3181c14930.

Reference Type BACKGROUND
PMID: 19934864 (View on PubMed)

Kheterpal S, Tremper KK, Heung M, Rosenberg AL, Englesbe M, Shanks AM, Campbell DA Jr. Development and validation of an acute kidney injury risk index for patients undergoing general surgery: results from a national data set. Anesthesiology. 2009 Mar;110(3):505-15. doi: 10.1097/ALN.0b013e3181979440.

Reference Type BACKGROUND
PMID: 19212261 (View on PubMed)

Aronson S, Stafford-Smith M, Phillips-Bute B, Shaw A, Gaca J, Newman M; Cardiothoracic Anesthesiology Research Endeavors. Intraoperative systolic blood pressure variability predicts 30-day mortality in aortocoronary bypass surgery patients. Anesthesiology. 2010 Aug;113(2):305-12. doi: 10.1097/ALN.0b013e3181e07ee9.

Reference Type BACKGROUND
PMID: 20571360 (View on PubMed)

Other Identifiers

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201102154

Identifier Type: -

Identifier Source: org_study_id

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