Ignite Creation Date:
2025-12-25 @ 4:11 AM
Ignite Modification Date:
2026-03-04 @ 10:55 PM
Study NCT ID:
NCT02726620
Status:
COMPLETED
Last Update Posted:
2019-05-16
First Post:
2016-03-28
Is NOT Gene Therapy:
True
Has Adverse Events:
True
Brief Title:
Decision Support for Intraoperative Low Blood Pressure
Sponsor:
Organization:
Raw JSON
{'hasResults': True, 'derivedSection': {'miscInfoModule': {'versionHolder': '2025-12-24'}, 'conditionBrowseModule': {'meshes': [{'id': 'D007022', 'term': 'Hypotension'}, {'id': 'D058186', 'term': 'Acute Kidney Injury'}], 'ancestors': [{'id': 'D014652', 'term': 'Vascular Diseases'}, {'id': 'D002318', 'term': 'Cardiovascular Diseases'}, {'id': 'D051437', 'term': 'Renal Insufficiency'}, {'id': 'D007674', 'term': 'Kidney Diseases'}, {'id': 'D014570', 'term': 'Urologic Diseases'}, {'id': 'D052776', 'term': 'Female Urogenital Diseases'}, {'id': 'D005261', 'term': 'Female Urogenital Diseases and Pregnancy Complications'}, {'id': 'D000091642', 'term': 'Urogenital Diseases'}, {'id': 'D052801', 'term': 'Male Urogenital Diseases'}]}, 'interventionBrowseModule': {'meshes': [{'id': 'D000768', 'term': 'Anesthesia, General'}, {'id': 'D000765', 'term': 'Anesthesia, Conduction'}, {'id': 'D000775', 'term': 'Anesthesia, Spinal'}, {'id': 'D000767', 'term': 'Anesthesia, Epidural'}, {'id': 'D015742', 'term': 'Propofol'}, {'id': 'D000077149', 'term': 'Sevoflurane'}, {'id': 'D000077335', 'term': 'Desflurane'}, {'id': 'D007530', 'term': 'Isoflurane'}, {'id': 'D004809', 'term': 'Ephedrine'}, {'id': 'D010656', 'term': 'Phenylephrine'}, {'id': 'D009638', 'term': 'Norepinephrine'}, {'id': 'D004837', 'term': 'Epinephrine'}, {'id': 'D004280', 'term': 'Dobutamine'}, {'id': 'D004298', 'term': 'Dopamine'}, {'id': 'D007545', 'term': 'Isoproterenol'}, {'id': 'D020105', 'term': 'Milrinone'}, {'id': 'D001285', 'term': 'Atropine'}, {'id': 'D006024', 'term': 'Glycopyrrolate'}, {'id': 'D014667', 'term': 'Vasopressins'}, {'id': 'D000077585', 'term': 'Terlipressin'}, {'id': 'D012965', 'term': 'Sodium Chloride'}, {'id': 'D000077325', 'term': "Ringer's Lactate"}, {'id': 'C012499', 'term': 'Plasma-lyte 148'}, {'id': 'D008012', 'term': 'Lidocaine'}, {'id': 'D002045', 'term': 'Bupivacaine'}, {'id': 'D000077554', 'term': 'Levobupivacaine'}, {'id': 'D000077212', 'term': 'Ropivacaine'}, {'id': 'D008619', 'term': 'Mepivacaine'}, {'id': 'D013748', 'term': 'Tetracaine'}, {'id': 'D011318', 'term': 'Prilocaine'}, {'id': 'D011343', 'term': 'Procaine'}, {'id': 'C004616', 'term': 'chloroprocaine'}, {'id': 'D001566', 'term': 'Benzocaine'}, {'id': 'D002355', 'term': 'Carticaine'}], 'ancestors': [{'id': 'D000758', 'term': 'Anesthesia'}, {'id': 'D000760', 'term': 'Anesthesia and Analgesia'}, {'id': 'D010636', 'term': 'Phenols'}, {'id': 'D001555', 'term': 'Benzene Derivatives'}, {'id': 'D006841', 'term': 'Hydrocarbons, Aromatic'}, {'id': 'D006844', 'term': 'Hydrocarbons, Cyclic'}, {'id': 'D006838', 'term': 'Hydrocarbons'}, {'id': 'D009930', 'term': 'Organic Chemicals'}, {'id': 'D008738', 'term': 'Methyl Ethers'}, {'id': 'D004987', 'term': 'Ethers'}, {'id': 'D006845', 'term': 'Hydrocarbons, Fluorinated'}, {'id': 'D006846', 'term': 'Hydrocarbons, Halogenated'}, {'id': 'D005019', 'term': 'Ethyl Ethers'}, {'id': 'D011412', 'term': 'Propanolamines'}, {'id': 'D000605', 'term': 'Amino Alcohols'}, {'id': 'D000438', 'term': 'Alcohols'}, {'id': 'D020005', 'term': 'Propanols'}, {'id': 'D000588', 'term': 'Amines'}, {'id': 'D010627', 'term': 'Phenethylamines'}, {'id': 'D005021', 'term': 'Ethylamines'}, {'id': 'D004983', 'term': 'Ethanolamines'}, {'id': 'D015306', 'term': 'Biogenic Monoamines'}, {'id': 'D001679', 'term': 'Biogenic Amines'}, {'id': 'D002395', 'term': 'Catecholamines'}, {'id': 'D002396', 'term': 'Catechols'}, {'id': 'D000676', 'term': 'Amrinone'}, {'id': 'D000631', 'term': 'Aminopyridines'}, {'id': 'D011725', 'term': 'Pyridines'}, {'id': 'D006573', 'term': 'Heterocyclic Compounds, 1-Ring'}, {'id': 'D006571', 'term': 'Heterocyclic Compounds'}, {'id': 'D001286', 'term': 'Atropine Derivatives'}, {'id': 'D014326', 'term': 'Tropanes'}, {'id': 'D053961', 'term': 'Azabicyclo Compounds'}, {'id': 'D001372', 'term': 'Aza Compounds'}, {'id': 'D001533', 'term': 'Belladonna Alkaloids'}, {'id': 'D012991', 'term': 'Solanaceous Alkaloids'}, {'id': 'D000470', 'term': 'Alkaloids'}, {'id': 'D019086', 'term': 'Bridged Bicyclo Compounds, Heterocyclic'}, {'id': 'D006572', 'term': 'Heterocyclic Compounds, Bridged-Ring'}, {'id': 'D000644', 'term': 'Quaternary Ammonium Compounds'}, {'id': 'D009861', 'term': 'Onium Compounds'}, {'id': 'D011759', 'term': 'Pyrrolidines'}, {'id': 'D010909', 'term': 'Pituitary Hormones, Posterior'}, {'id': 'D010907', 'term': 'Pituitary Hormones'}, {'id': 'D036361', 'term': 'Peptide Hormones'}, {'id': 'D006728', 'term': 'Hormones'}, {'id': 'D006730', 'term': 'Hormones, Hormone Substitutes, and Hormone Antagonists'}, {'id': 'D009479', 'term': 'Neuropeptides'}, {'id': 'D010455', 'term': 'Peptides'}, {'id': 'D000602', 'term': 'Amino Acids, Peptides, and Proteins'}, {'id': 'D009842', 'term': 'Oligopeptides'}, {'id': 'D009419', 'term': 'Nerve Tissue Proteins'}, {'id': 'D011506', 'term': 'Proteins'}, {'id': 'D008236', 'term': 'Lypressin'}, {'id': 'D002712', 'term': 'Chlorides'}, {'id': 'D006851', 'term': 'Hydrochloric Acid'}, {'id': 'D017606', 'term': 'Chlorine Compounds'}, {'id': 'D007287', 'term': 'Inorganic Chemicals'}, {'id': 'D017670', 'term': 'Sodium Compounds'}, {'id': 'D000077324', 'term': 'Crystalloid Solutions'}, {'id': 'D007552', 'term': 'Isotonic Solutions'}, {'id': 'D012996', 'term': 'Solutions'}, {'id': 'D004364', 'term': 'Pharmaceutical Preparations'}, {'id': 'D000083', 'term': 'Acetanilides'}, {'id': 'D000813', 'term': 'Anilides'}, {'id': 'D000577', 'term': 'Amides'}, {'id': 'D000814', 'term': 'Aniline Compounds'}, {'id': 'D010880', 'term': 'Piperidines'}, {'id': 'D062366', 'term': 'para-Aminobenzoates'}, {'id': 'D062365', 'term': 'Aminobenzoates'}, {'id': 'D001565', 'term': 'Benzoates'}, {'id': 'D000146', 'term': 'Acids, Carbocyclic'}, {'id': 'D002264', 'term': 'Carboxylic Acids'}, {'id': 'D013876', 'term': 'Thiophenes'}, {'id': 'D013457', 'term': 'Sulfur Compounds'}]}}, 'resultsSection': {'moreInfoModule': {'pointOfContact': {'email': 'jon.wanderer@vanderbilt.edu', 'phone': '615-536-5194', 'title': 'Jonathan Wanderer', 'organization': 'Vanderbilt University Medical Center'}, 'certainAgreement': {'piSponsorEmployee': True}, 'limitationsAndCaveats': {'description': "1. Due to development issues the UMC Utrecht could not participate: myocardial injury was dropped as primary outcome, as well as some secondary outcomes.\n2. Technical issues at the VUMC resulted in absent IOH notifications (see 'Participant Flow')."}}, 'adverseEventsModule': {'timeFrame': 'We analyzed adverse events in this patient population during their intraoperative course (adverse events sourced from our adverse event reporting system; from entry into OR to exit from OR), and during their hospitalization (source for mortality data; from hospital admission to hospital discharge).', 'description': "We utilized our perioperative information management system to determine the number of adverse events that occurred associated with the patients' intraoperative course. We used our hospital registration system to determine all cause mortality for this patient population.", 'eventGroups': [{'id': 'EG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm).", 'otherNumAtRisk': 17463, 'deathsNumAtRisk': 17463, 'otherNumAffected': 0, 'seriousNumAtRisk': 17463, 'deathsNumAffected': 534, 'seriousNumAffected': 1811}, {'id': 'EG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.', 'otherNumAtRisk': 4972, 'deathsNumAtRisk': 4972, 'otherNumAffected': 0, 'seriousNumAtRisk': 4972, 'deathsNumAffected': 158, 'seriousNumAffected': 541}], 'seriousEvents': [{'term': 'Acute Kidney Injury Stage I or greater', 'notes': 'KDIGO (Kidney Disease: Improving Global Outcomes) Stage I or greater within the first seven postoperative days of surgery. Only based on creatinine measurements as part of routine clinical care, not urine output (inadequate documentation).', 'stats': [{'groupId': 'EG000', 'numAtRisk': 17463, 'numAffected': 1477}, {'groupId': 'EG001', 'numAtRisk': 4972, 'numAffected': 435}], 'organSystem': 'Renal and urinary disorders', 'assessmentType': 'SYSTEMATIC_ASSESSMENT'}, {'term': 'Mortality', 'stats': [{'groupId': 'EG000', 'numAtRisk': 17463, 'numAffected': 534}, {'groupId': 'EG001', 'numAtRisk': 4972, 'numAffected': 158}], 'organSystem': 'Investigations', 'assessmentType': 'SYSTEMATIC_ASSESSMENT'}], 'frequencyThreshold': '5'}, 'outcomeMeasuresModule': {'outcomeMeasures': [{'type': 'PRIMARY', 'title': 'Postoperative Acute Kidney Injury', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'title': 'AKI stage I or greater', 'measurements': [{'value': '1333', 'groupId': 'OG000'}, {'value': '372', 'groupId': 'OG001'}]}, {'title': 'No AKI - Confirmed by measurement', 'measurements': [{'value': '9670', 'groupId': 'OG000'}, {'value': '2785', 'groupId': 'OG001'}]}, {'title': 'No postoperative creatinine measurement', 'measurements': [{'value': '4621', 'groupId': 'OG000'}, {'value': '1171', 'groupId': 'OG001'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'timeFrame': 'Within 7 days after surgery', 'description': "Postoperative Acute Kidney Injury (AKI), Stage I or higher according to the KDIGO criteria (Kidney Disease: Improving Global Outcomes). The staging will be based on serum creatinine values, as documentation of urine output is probably not sufficiently accurate. This will be the primary outcome for the Vanderbilt University Medical Center. The creatinine measurements are part of routine clinical care. Therefore, absence of creatinine postoperative measurements are considered to be 'no suspicion of kidney injury'. KDIGO defines AKI as any of the following: Increase in serum creatinine by 0.3mg/dL or more within 48 hours or Increase in serum creatinine to 1.5 times baseline or more within the last 7 days or Urine output less than 0.5 mL/kg/h for 6 hours. Stage 1 is 1.5-9x baseline or \\>0.3 increase; Stage 2 is 2-2.9x baseline; Stage 3 is 3x baseline, or increase to \\> 4, or initiation of renal replacement therapy.", 'unitOfMeasure': 'Participants', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'SECONDARY', 'title': '30-day Mortality', 'denoms': [{'units': 'Participants', 'counts': [{'value': '4667', 'groupId': 'OG000'}, {'value': '1285', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '511', 'groupId': 'OG000'}, {'value': '143', 'groupId': 'OG001'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'timeFrame': '30 days after surgery', 'description': "Vanderbilt University Medical Center: combination of in-hospital mortality and 'alive-index' (which checks for visits to the hospital in the electronic healthcare record as indication of being alive at 30 days)", 'unitOfMeasure': 'Participants', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section). For a large group of patients no mortality information was available."}, {'type': 'SECONDARY', 'title': 'In-hospital Mortality', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '487', 'groupId': 'OG000'}, {'value': '137', 'groupId': 'OG001'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'timeFrame': 'All postoperative days during a single hospital admission, expected median of 5 days', 'description': 'Hospital mortality rate during a single hospital admission after the surgery', 'unitOfMeasure': 'Participants', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'SECONDARY', 'title': 'Postoperative Acute Kidney Injury Stage 2', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'title': 'AKI stage II or greater', 'measurements': [{'value': '1', 'groupId': 'OG000'}, {'value': '0', 'groupId': 'OG001'}]}, {'title': 'No stage II or greater - Confirmed by measurement', 'measurements': [{'value': '11002', 'groupId': 'OG000'}, {'value': '3157', 'groupId': 'OG001'}]}, {'title': 'No postoperative creatinine measurement', 'measurements': [{'value': '4621', 'groupId': 'OG000'}, {'value': '1171', 'groupId': 'OG001'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'timeFrame': 'Within 7 days after surgery', 'description': "Postoperative Acute Kidney Injury (AKI), Stage II or higher according to the KDIGO criteria (Kidney Disease: Improving Global Outcomes). The staging will be based on serum creatinine values, as documentation of urine output is probably not sufficiently accurate. The creatinine measurements are part of routine clinical care. Therefore, absence of creatinine postoperative measurements are considered to be 'no suspicion of kidney injury'. KDIGO defines AKI as any of the following: Increase in serum creatinine by 0.3mg/dL or more within 48 hours or Increase in serum creatinine to 1.5 times baseline or more within the last 7 days or Urine output less than 0.5 mL/kg/h for 6 hours. Stage 1 is 1.5-9x baseline or \\>0.3 increase; Stage 2 is 2-2.9x baseline; Stage 3 is 3x baseline, or increase to \\> 4, or initiation of renal replacement therapy.", 'unitOfMeasure': 'Participants', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'SECONDARY', 'title': 'Postoperative Rise in Creatinine Levels', 'denoms': [{'units': 'Participants', 'counts': [{'value': '11003', 'groupId': 'OG000'}, {'value': '3157', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '0.00', 'groupId': 'OG000', 'lowerLimit': '-0.10', 'upperLimit': '0.13'}, {'value': '0.00', 'groupId': 'OG001', 'lowerLimit': '-0.09', 'upperLimit': '0.14'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'Within 7 days after surgery', 'description': 'Absolute values for serum creatinine before and after surgery will be compared. When multiple postoperative creatinine measurements are made, the maximum difference is reported.', 'unitOfMeasure': 'mg/dL', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section). Patients with no routine postoperative creatinine measurements are excluded from the analysis."}, {'type': 'SECONDARY', 'title': 'Incidence of a MAP < 60 mmHg', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '13779', 'groupId': 'OG000'}, {'value': '3798', 'groupId': 'OG001'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Incidence of a mean arterial pressure (MAP) \\< 60 mmHg during anesthesia for 1 minute or more.', 'unitOfMeasure': 'Participants', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'SECONDARY', 'title': 'Incidence of a MAP < 55 mmHg', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '10991', 'groupId': 'OG000'}, {'value': '3045', 'groupId': 'OG001'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Incidence of a mean arterial pressure (MAP) \\< 55 mmHg during anesthesia for 1 minute or more.', 'unitOfMeasure': 'Participants', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'SECONDARY', 'title': 'Incidence of a MAP < 50 mmHg', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '7781', 'groupId': 'OG000'}, {'value': '2196', 'groupId': 'OG001'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Incidence of a mean arterial pressure (MAP) \\< 50 mmHg during anesthesia for 1 minute or more.', 'unitOfMeasure': 'Participants', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'SECONDARY', 'title': 'Incidence of a MAP < 60 mmHg for > 10 Minutes', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '6989', 'groupId': 'OG000'}, {'value': '1723', 'groupId': 'OG001'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Incidence of a mean arterial pressure (MAP) \\< 60 mmHg for a cumulative duration of all hypotensive episodes of more than 10 minutes during the anesthetic phase of the procedure.', 'unitOfMeasure': 'Participants', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'SECONDARY', 'title': 'Incidence of a MAP < 55 mmHg for > 10 Minutes', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '3181', 'groupId': 'OG000'}, {'value': '759', 'groupId': 'OG001'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Incidence of a mean arterial pressure (MAP) \\< 55 mmHg for a cumulative duration of all hypotensive episodes of more than 10 minutes during the anesthetic phase of the procedure.', 'unitOfMeasure': 'Participants', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'SECONDARY', 'title': 'Incidence of a MAP < 50 mmHg for > 10 Minutes', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '1159', 'groupId': 'OG000'}, {'value': '326', 'groupId': 'OG001'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Incidence of a mean arterial pressure (MAP) \\< 50 mmHg for a cumulative duration of all hypotensive episodes of more than 10 minutes during the anesthetic phase of the procedure.', 'unitOfMeasure': 'Participants', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'SECONDARY', 'title': 'Incidence of a MAP < 60 mmHg for > 20 Minutes', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '3632', 'groupId': 'OG000'}, {'value': '792', 'groupId': 'OG001'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Incidence of a mean arterial pressure (MAP) \\< 60 mmHg for a cumulative duration of all hypotensive episodes of more than 20 minutes during the anesthetic phase of the procedure.', 'unitOfMeasure': 'Participants', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'SECONDARY', 'title': 'Incidence of a MAP < 55 mmHg for > 20 Minutes', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '1223', 'groupId': 'OG000'}, {'value': '284', 'groupId': 'OG001'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Incidence of a mean arterial pressure (MAP) \\< 55 mmHg for a cumulative duration of all hypotensive episodes of more than 20 minutes during the anesthetic phase of the procedure.', 'unitOfMeasure': 'Participants', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'SECONDARY', 'title': 'Incidence of a MAP < 50 mmHg for > 20 Minutes', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '304', 'groupId': 'OG000'}, {'value': '85', 'groupId': 'OG001'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Incidence of a mean arterial pressure (MAP) \\< 50 mmHg for a cumulative duration of all hypotensive episodes of more than 20 minutes during the anesthetic phase of the procedure.', 'unitOfMeasure': 'Participants', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'SECONDARY', 'title': 'Depth and Duration of Intraoperative Hypotension - Threshold MAP 75 mmHg', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '485', 'groupId': 'OG000', 'lowerLimit': '243', 'upperLimit': '915'}, {'value': '417', 'groupId': 'OG001', 'lowerLimit': '206', 'upperLimit': '764'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Depth and duration of intraoperative hypotension will be modeled by calculating areas under the threshold for mean arterial pressures (MAPs). Thresholds will vary from 75 mmHg to 50 mmHg in 5 mmHg decrements. Together these variables represent the depth and duration of intraoperative hypotension. To optimize goodness of fit of these variables, the decremental steps may be increased to 10 mmHg and more restrictive lowest and highest thresholds may be chosen for the statistical analysis.', 'unitOfMeasure': 'mmHg*minute', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'SECONDARY', 'title': 'Depth and Duration of Intraoperative Hypotension - Threshold MAP 70 mmHg', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '273', 'groupId': 'OG000', 'lowerLimit': '126', 'upperLimit': '543'}, {'value': '235', 'groupId': 'OG001', 'lowerLimit': '109', 'upperLimit': '451'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Depth and duration of intraoperative hypotension will be modeled by calculating areas under the threshold for mean arterial pressures (MAPs). Thresholds will vary from 75 mmHg to 50 mmHg in 5 mmHg decrements. Together these variables represent the depth and duration of intraoperative hypotension. To optimize goodness of fit of these variables, the decremental steps may be increased to 10 mmHg and more restrictive lowest and highest thresholds may be chosen for the statistical analysis.', 'unitOfMeasure': 'mmHg*minute', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'SECONDARY', 'title': 'Depth and Duration of Intraoperative Hypotension - Threshold MAP 65 mmHg', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '96', 'groupId': 'OG000', 'lowerLimit': '34', 'upperLimit': '225'}, {'value': '86', 'groupId': 'OG001', 'lowerLimit': '30', 'upperLimit': '193'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Depth and duration of intraoperative hypotension will be modeled by calculating areas under the threshold for mean arterial pressures (MAPs). Thresholds will vary from 75 mmHg to 50 mmHg in 5 mmHg decrements. Together these variables represent the depth and duration of intraoperative hypotension. To optimize goodness of fit of these variables, the decremental steps may be increased to 10 mmHg and more restrictive lowest and highest thresholds may be chosen for the statistical analysis.', 'unitOfMeasure': 'mmHg*minute', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'SECONDARY', 'title': 'Depth and Duration of Intraoperative Hypotension - Threshold MAP 60 mmHg', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '57', 'groupId': 'OG000', 'lowerLimit': '21', 'upperLimit': '131'}, {'value': '52', 'groupId': 'OG001', 'lowerLimit': '20', 'upperLimit': '117'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Depth and duration of intraoperative hypotension will be modeled by calculating areas under the threshold for mean arterial pressures (MAPs). Thresholds will vary from 75 mmHg to 50 mmHg in 5 mmHg decrements. Together these variables represent the depth and duration of intraoperative hypotension. To optimize goodness of fit of these variables, the decremental steps may be increased to 10 mmHg and more restrictive lowest and highest thresholds may be chosen for the statistical analysis.', 'unitOfMeasure': 'mmHg*minute', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'SECONDARY', 'title': 'Depth and Duration of Intraoperative Hypotension - Threshold MAP 55 mmHg', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '23', 'groupId': 'OG000', 'lowerLimit': '5', 'upperLimit': '59'}, {'value': '23', 'groupId': 'OG001', 'lowerLimit': '5', 'upperLimit': '62'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Depth and duration of intraoperative hypotension will be modeled by calculating areas under the threshold for mean arterial pressures (MAPs). Thresholds will vary from 75 mmHg to 50 mmHg in 5 mmHg decrements. Together these variables represent the depth and duration of intraoperative hypotension. To optimize goodness of fit of these variables, the decremental steps may be increased to 10 mmHg and more restrictive lowest and highest thresholds may be chosen for the statistical analysis.', 'unitOfMeasure': 'mmHg*minute', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'SECONDARY', 'title': 'Depth and Duration of Intraoperative Hypotension - Threshold MAP 50 mmHg', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '19', 'groupId': 'OG000', 'lowerLimit': '7', 'upperLimit': '43'}, {'value': '19', 'groupId': 'OG001', 'lowerLimit': '8', 'upperLimit': '47'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Depth and duration of intraoperative hypotension will be modeled by calculating areas under the threshold for mean arterial pressures (MAPs). Thresholds will vary from 75 mmHg to 50 mmHg in 5 mmHg decrements. Together these variables represent the depth and duration of intraoperative hypotension. To optimize goodness of fit of these variables, the decremental steps may be increased to 10 mmHg and more restrictive lowest and highest thresholds may be chosen for the statistical analysis.', 'unitOfMeasure': 'mmHg*minute', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'SECONDARY', 'title': 'Estimated Intraoperative Blood Loss', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '100', 'groupId': 'OG000', 'lowerLimit': '25', 'upperLimit': '250'}, {'value': '75', 'groupId': 'OG001', 'lowerLimit': '20', 'upperLimit': '200'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the surgical procedure: an expected average of 2 hours', 'description': 'The estimated blood loss in mL during the surgical procedure', 'unitOfMeasure': 'mL', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'SECONDARY', 'title': 'Time to Discharge Readiness at the Postanesthesia Care Unit (PACU)', 'denoms': [{'units': 'Participants', 'counts': [{'value': '13082', 'groupId': 'OG000'}, {'value': '3580', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '67', 'groupId': 'OG000', 'lowerLimit': '46', 'upperLimit': '101'}, {'value': '60', 'groupId': 'OG001', 'lowerLimit': '42', 'upperLimit': '89.25'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'A specific time frame on the day of surgery: from the start of admission to the PACU to discharge from the PACU, an expected average of 4 hours', 'description': 'The time from arriving at the postanesthesia care unit (PACU) until the time the patient is considered ready for discharge (in minutes).', 'unitOfMeasure': 'minutes', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': "Only patients with a postoperative stay at the postanesthesia care unit (PACU). Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'SECONDARY', 'title': 'Intravenous Anesthetic Drug Use During Intraoperative Hypotension: MAP < 65 mmHg', 'denoms': [{'units': 'Participants', 'counts': [{'value': '14333', 'groupId': 'OG000'}, {'value': '3926', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '60.10', 'groupId': 'OG000', 'lowerLimit': '35', 'upperLimit': '100'}, {'value': '48.59', 'groupId': 'OG001', 'lowerLimit': '28.55', 'upperLimit': '83.88'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Average concentrations of propofol infusion rates during MAP \\< 65 mmHg episodes', 'unitOfMeasure': 'mcg/kg/min (propofol)', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': 'All patients with any MAP \\< 65 mmHg and a continuous administration of one of the following anesthetics: propofol, sevoflurane, isoflurane, desflurane. On occasion, the anesthesiologist may switch between anesthetic drugs. The numbers analyzed in one or more rows thus does not match the overall number analyzed.'}, {'type': 'SECONDARY', 'title': 'Intravenous Anesthetic Drug Use During Intraoperative Hypotension: MAP < 60 mmHg', 'denoms': [{'units': 'Participants', 'counts': [{'value': '11621', 'groupId': 'OG000'}, {'value': '3145', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '61.07', 'groupId': 'OG000', 'lowerLimit': '37.39', 'upperLimit': '100.00'}, {'value': '50.00', 'groupId': 'OG001', 'lowerLimit': '27.65', 'upperLimit': '81.50'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Average concentrations of propofol infusion rates during MAP \\< 60 mmHg episodes', 'unitOfMeasure': 'mcg/kg/min (propofol)', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': 'All patients with any MAP \\< 60 mmHg and either a continuous administration of one of the following anesthetics: propofol, sevoflurane, isoflurane, desflurane. On occasion, the anesthesiologist may switch between anesthetic drugs. The numbers analyzed in one or more rows thus does not match the overall number analyzed.'}, {'type': 'SECONDARY', 'title': 'Intravenous Anesthetic Drug Use During Intraoperative Hypotension: MAP < 55 mmHg', 'denoms': [{'units': 'Participants', 'counts': [{'value': '8254', 'groupId': 'OG000'}, {'value': '2196', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '63.95', 'groupId': 'OG000', 'lowerLimit': '37.50', 'upperLimit': '100.00'}, {'value': '50.00', 'groupId': 'OG001', 'lowerLimit': '29.12', 'upperLimit': '83.33'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Average concentrations of propofol infusion rates during MAP \\< 55 mmHg episodes', 'unitOfMeasure': 'mcg/kg/min (propofol)', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': 'All patients with any MAP \\< 55 mmHg and either a continuous administration of one of the following anesthetics: propofol, sevoflurane, isoflurane, desflurane. On occasion, the anesthesiologist may switch between anesthetic drugs. The numbers analyzed in one or more rows thus does not match the overall number analyzed.'}, {'type': 'SECONDARY', 'title': 'Intravenous Anesthetic Drug Use During Intraoperative Hypotension: MAP < 50 mmHg', 'denoms': [{'units': 'Participants', 'counts': [{'value': '5135', 'groupId': 'OG000'}, {'value': '1413', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '65.00', 'groupId': 'OG000', 'lowerLimit': '40.00', 'upperLimit': '100.00'}, {'value': '50.00', 'groupId': 'OG001', 'lowerLimit': '30.00', 'upperLimit': '82.71'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Average concentrations of propofol infusion rates during MAP \\< 50 mmHg episodes', 'unitOfMeasure': 'mcg/kg/min (propofol)', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': 'All patients with any MAP \\< 50 mmHg and a continuous administration of one of the following anesthetics: propofol, sevoflurane, isoflurane, desflurane. On occasion, the anesthesiologist may switch between anesthetic drugs. The numbers analyzed in one or more rows thus does not match the overall number analyzed.'}, {'type': 'SECONDARY', 'title': 'Average Use of Cardiovascular Drugs: Ephedrine', 'denoms': [{'units': 'Participants', 'counts': [{'value': '9310', 'groupId': 'OG000'}, {'value': '2718', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '20', 'groupId': 'OG000', 'lowerLimit': '10', 'upperLimit': '25'}, {'value': '15', 'groupId': 'OG001', 'lowerLimit': '10', 'upperLimit': '25'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Average use for each drug will be calculated. Cardiovascular drugs that were given in \\<1% of cases are not reported, as the average dosages would be meaningless.', 'unitOfMeasure': 'mg', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section). In addition, only patients that actually received any ephedrine are analyzed."}, {'type': 'SECONDARY', 'title': 'Average Use of Cardiovascular Drugs: Phenylephrine', 'denoms': [{'units': 'Participants', 'counts': [{'value': '12211', 'groupId': 'OG000'}, {'value': '3685', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '0.90', 'groupId': 'OG000', 'lowerLimit': '0.30', 'upperLimit': '3.69'}, {'value': '1.30', 'groupId': 'OG001', 'lowerLimit': '0.40', 'upperLimit': '5.03'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Average use for each drug will be calculated. Cardiovascular drugs that were given in \\<1% of cases are not reported, as the average dosage would be meaningless.', 'unitOfMeasure': 'mg', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section). In addition, only patients that actually received any phenylephrine are analyzed."}, {'type': 'SECONDARY', 'title': 'Average Use of Cardiovascular Drugs: Glycopyrrolate', 'denoms': [{'units': 'Participants', 'counts': [{'value': '11093', 'groupId': 'OG000'}, {'value': '1257', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '0.40', 'groupId': 'OG000', 'lowerLimit': '0.40', 'upperLimit': '0.60'}, {'value': '0.40', 'groupId': 'OG001', 'lowerLimit': '0.20', 'upperLimit': '0.40'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Average use for each drug will be calculated. Cardiovascular drugs that were given in \\<1% of cases are not reported, as the average dosage would be meaningless.', 'unitOfMeasure': 'mg', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section). In addition, only patients that actually received any glycopyrrolate are analyzed."}, {'type': 'SECONDARY', 'title': 'Average Use of Cardiovascular Drugs: Epinephrine', 'denoms': [{'units': 'Participants', 'counts': [{'value': '1215', 'groupId': 'OG000'}, {'value': '409', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '1.00', 'groupId': 'OG000', 'lowerLimit': '0.50', 'upperLimit': '2.00'}, {'value': '0.70', 'groupId': 'OG001', 'lowerLimit': '0.50', 'upperLimit': '2.00'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Average use for each drug will be calculated. Cardiovascular drugs that were given in \\<1% of cases are not reported, as the average dosage would be meaningless.', 'unitOfMeasure': 'mg', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section). In addition, only patients that actually received any epinephrine are analyzed."}, {'type': 'SECONDARY', 'title': 'Average Use of Cardiovascular Drugs: Norepinephrine', 'denoms': [{'units': 'Participants', 'counts': [{'value': '762', 'groupId': 'OG000'}, {'value': '233', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '0.62', 'groupId': 'OG000', 'lowerLimit': '0.27', 'upperLimit': '1.35'}, {'value': '0.70', 'groupId': 'OG001', 'lowerLimit': '0.33', 'upperLimit': '1.56'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Average use for each drug will be calculated. Cardiovascular drugs that were given in \\<1% of cases are not reported, as the average dosage would be meaningless.', 'unitOfMeasure': 'mg', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section). In addition, only patients that actually received any norepinephrine are analyzed."}, {'type': 'SECONDARY', 'title': 'Timing of Cardiovascular Drugs for MAP < 65 mmHg', 'denoms': [{'units': 'Participants', 'counts': [{'value': '13932', 'groupId': 'OG000'}, {'value': '3975', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '2', 'groupId': 'OG000', 'lowerLimit': '0.4', 'upperLimit': '4'}, {'value': '1.14', 'groupId': 'OG001', 'lowerLimit': '0', 'upperLimit': '3'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Time of first administration of cardiovascular drug relative to the time at which the mean arterial pressure (MAP) drops below 60 mmHg. Per patient the average time to first administration of all hypotensive episodes was calculated. That average time is used as the outcome variable. A negative value indicates that administration occurred before the drop in MAP.', 'unitOfMeasure': 'minutes', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': 'All patients with any MAP \\< 65 mmHg and an administration event of a cardiovascular drugs within 5 minutes before the start of the hypotensive episode (the first value below 65 mmHg) and 15 minutes after the start of the episode.'}, {'type': 'SECONDARY', 'title': 'Timing of Cardiovascular Drugs for MAP < 60 mmHg', 'denoms': [{'units': 'Participants', 'counts': [{'value': '12292', 'groupId': 'OG000'}, {'value': '3458', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '0.8', 'groupId': 'OG000', 'lowerLimit': '-0.370', 'upperLimit': '2.5'}, {'value': '1.5', 'groupId': 'OG001', 'lowerLimit': '0', 'upperLimit': '3.5'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Time of first administration of cardiovascular drug relative to the time at which the mean arterial pressure (MAP) drops below 60 mmHg. Per patient the average time to first administration of all hypotensive episodes was calculated. That average time is used as the outcome variable. A negative value indicates that administration occurred before the drop in MAP.', 'unitOfMeasure': 'minutes', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': 'All patients with any MAP \\< 60 mmHg and an administration event of a cardiovascular drugs within 5 minutes before the start of the hypotensive episode (the first value below 60 mmHg) and 15 minutes after the start of the episode.'}, {'type': 'SECONDARY', 'title': 'Timing of Cardiovascular Drugs for MAP < 55 mmHg', 'denoms': [{'units': 'Participants', 'counts': [{'value': '9706', 'groupId': 'OG000'}, {'value': '2752', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '1', 'groupId': 'OG000', 'lowerLimit': '-0.333', 'upperLimit': '3'}, {'value': '0.5', 'groupId': 'OG001', 'lowerLimit': '-0.75', 'upperLimit': '2.33'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Time of first administration of cardiovascular drug relative to the time at which the mean arterial pressure (MAP) drops below 55 mmHg. Per patient the average time to first administration of all hypotensive episodes was calculated. That average time is used as the outcome variable. A negative value indicates that administration occurred before the drop in MAP.', 'unitOfMeasure': 'minutes', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': 'All patients with any MAP \\< 55 mmHg and an administration event of a cardiovascular drugs within 5 minutes before the start of the hypotensive episode (the first value below 55 mmHg) and 15 minutes after the start of the episode.'}, {'type': 'SECONDARY', 'title': 'Timing of Cardiovascular Drugs for MAP < 50 mmHg', 'denoms': [{'units': 'Participants', 'counts': [{'value': '6789', 'groupId': 'OG000'}, {'value': '1989', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '1', 'groupId': 'OG000', 'lowerLimit': '-0.833', 'upperLimit': '3'}, {'value': '0', 'groupId': 'OG001', 'lowerLimit': '-1', 'upperLimit': '2.17'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Time of first administration of cardiovascular drug relative to the time at which the mean arterial pressure (MAP) drops below 50 mmHg. Per patient the average time to first administration of all hypotensive episodes was calculated. That average time is used as the outcome variable. A negative value indicates that administration occurred before the drop in MAP.', 'unitOfMeasure': 'minutes', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': 'All patients with any MAP \\< 50 mmHg and an administration event of a cardiovascular drugs within 5 minutes before the start of the hypotensive episode (the first value below 50 mmHg) and 15 minutes after the start of the episode.'}, {'type': 'SECONDARY', 'title': 'Intraoperative Administration of Intravenous Fluids', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '1500.00', 'groupId': 'OG000', 'lowerLimit': '1000.00', 'upperLimit': '2300.00'}, {'value': '1400.00', 'groupId': 'OG001', 'lowerLimit': '1000.00', 'upperLimit': '2000.00'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Total amount (mL) of intravenous fluids (as defined under interventions) administered during the surgical procedure.', 'unitOfMeasure': 'mL', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'POST_HOC', 'title': 'Postoperative Acute Kidney Injury', 'denoms': [{'units': 'Participants', 'counts': [{'value': '17463', 'groupId': 'OG000'}, {'value': '4972', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'title': 'AKI stage I or greater', 'measurements': [{'value': '1477', 'groupId': 'OG000'}, {'value': '435', 'groupId': 'OG001'}]}, {'title': 'No AKI - Confirmed by measurement', 'measurements': [{'value': '10690', 'groupId': 'OG000'}, {'value': '3166', 'groupId': 'OG001'}]}, {'title': 'No postoperative creatinine measurement', 'measurements': [{'value': '5296', 'groupId': 'OG000'}, {'value': '1371', 'groupId': 'OG001'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'timeFrame': 'Within 7 days after surgery', 'description': "Postoperative Acute Kidney Injury (AKI), Stage I or higher according to the KDIGO criteria (Kidney Disease: Improving Global Outcomes). The staging will be based on serum creatinine values, as documentation of urine output is probably not sufficiently accurate. This will be the primary outcome for the Vanderbilt University Medical Center. The creatinine measurements are part of routine clinical care. Therefore, absence of creatinine postoperative measurements are considered to be 'no suspicion of kidney injury'. KDIGO defines AKI as any of the following: Increase in serum creatinine by 0.3mg/dL or more within 48 hours or Increase in serum creatinine to 1.5 times baseline or more within the last 7 days or Urine output less than 0.5 mL/kg/h for 6 hours. Stage 1 is 1.5-9x baseline or \\>0.3 increase; Stage 2 is 2-2.9x baseline; Stage 3 is 3x baseline, or increase to \\> 4, or initiation of renal replacement therapy.", 'unitOfMeasure': 'Participants', 'reportingStatus': 'POSTED', 'populationDescription': 'Post-Hoc analysis: all patients, not only those with any MAP \\< 65 mmHg.'}, {'type': 'POST_HOC', 'title': 'Usage Frequency of Cardiovascular Drugs: Ephedrine', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '9310', 'groupId': 'OG000'}, {'value': '2718', 'groupId': 'OG001'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Frequency of patients receiving the drug. Cardiovascular drugs that were given in \\<1% of cases are not reported.', 'unitOfMeasure': 'Participants', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'POST_HOC', 'title': 'Usage Frequency of Cardiovascular Drugs: Phenylephrine', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '12211', 'groupId': 'OG000'}, {'value': '3685', 'groupId': 'OG001'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Frequency of patients receiving the drug. Cardiovascular drugs that were given in \\<1% of cases are not reported.', 'unitOfMeasure': 'Participants', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'POST_HOC', 'title': 'Usage Frequency of Cardiovascular Drugs: Glycopyrrolate', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '11093', 'groupId': 'OG000'}, {'value': '1257', 'groupId': 'OG001'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Frequency of patients receiving the drug. Cardiovascular drugs that were given in \\<1% of cases are not reported.', 'unitOfMeasure': 'Participants', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'POST_HOC', 'title': 'Usage Frequency of Cardiovascular Drugs: Ephinephrine', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '1215', 'groupId': 'OG000'}, {'value': '409', 'groupId': 'OG001'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Frequency of patients receiving the drug. Cardiovascular drugs that were given in \\<1% of cases are not reported.', 'unitOfMeasure': 'Participants', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'POST_HOC', 'title': 'Usage Frequency of Cardiovascular Drugs: Norepinephrine', 'denoms': [{'units': 'Participants', 'counts': [{'value': '15624', 'groupId': 'OG000'}, {'value': '4328', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'categories': [{'measurements': [{'value': '762', 'groupId': 'OG000'}, {'value': '233', 'groupId': 'OG001'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Frequency of patients receiving the drug. Cardiovascular drugs that were given in \\<1% of cases are not reported.', 'unitOfMeasure': 'Participants', 'reportingStatus': 'POSTED', 'populationDescription': "Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis (See also 'Participant Flow' section)."}, {'type': 'SECONDARY', 'title': 'Inhaled Anesthetic Drug Use During Intraoperative Hypotension: MAP < 65 mmHg', 'denoms': [{'units': 'Participants', 'counts': [{'value': '14333', 'groupId': 'OG000'}, {'value': '3926', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'title': 'Sevoflurane (EndTidal %)', 'denoms': [{'units': 'Participants', 'counts': [{'value': '4589', 'groupId': 'OG000'}, {'value': '1258', 'groupId': 'OG001'}]}], 'categories': [{'measurements': [{'value': '1.35', 'groupId': 'OG000', 'lowerLimit': '1.03', 'upperLimit': '1.6'}, {'value': '1.27', 'groupId': 'OG001', 'lowerLimit': '0.98', 'upperLimit': '1.55'}]}]}, {'title': 'Isoflurane (EndTidal %)', 'denoms': [{'units': 'Participants', 'counts': [{'value': '9325', 'groupId': 'OG000'}, {'value': '2522', 'groupId': 'OG001'}]}], 'categories': [{'measurements': [{'value': '0.68', 'groupId': 'OG000', 'lowerLimit': '0.56', 'upperLimit': '0.80'}, {'value': '0.68', 'groupId': 'OG001', 'lowerLimit': '0.56', 'upperLimit': '0.80'}]}]}, {'title': 'Desflurane (EndTidal %)', 'denoms': [{'units': 'Participants', 'counts': [{'value': '63', 'groupId': 'OG000'}, {'value': '2', 'groupId': 'OG001'}]}], 'categories': [{'measurements': [{'value': '4.10', 'groupId': 'OG000', 'lowerLimit': '3.31', 'upperLimit': '4.64'}, {'value': '2.31', 'groupId': 'OG001', 'lowerLimit': '1.15', 'upperLimit': '3.46'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Average concentrations of inhalational anesthesia during MAP \\< 65 mmHg episodes', 'unitOfMeasure': 'EndTidal% (other)', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': 'All patients with any MAP \\< 65 mmHg and a continuous administration of one of the following anesthetics: propofol, sevoflurane, isoflurane, desflurane. On occasion, the anesthesiologist may switch between anesthetic drugs. The numbers analyzed in one or more rows thus does not match the overall number analyzed.'}, {'type': 'SECONDARY', 'title': 'Inhaled Anesthetic Drug Use During Intraoperative Hypotension: MAP < 60 mmHg', 'denoms': [{'units': 'Participants', 'counts': [{'value': '11621', 'groupId': 'OG000'}, {'value': '3145', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'title': 'Sevoflurane (EndTidal %)', 'denoms': [{'units': 'Participants', 'counts': [{'value': '3656', 'groupId': 'OG000'}, {'value': '997', 'groupId': 'OG001'}]}], 'categories': [{'measurements': [{'value': '1.35', 'groupId': 'OG000', 'lowerLimit': '1.02', 'upperLimit': '1.62'}, {'value': '1.25', 'groupId': 'OG001', 'lowerLimit': '0.95', 'upperLimit': '1.57'}]}]}, {'title': 'Isoflurane (EndTidal %)', 'denoms': [{'units': 'Participants', 'counts': [{'value': '7400', 'groupId': 'OG000'}, {'value': '1949', 'groupId': 'OG001'}]}], 'categories': [{'measurements': [{'value': '0.68', 'groupId': 'OG000', 'lowerLimit': '0.55', 'upperLimit': '0.80'}, {'value': '0.67', 'groupId': 'OG001', 'lowerLimit': '0.55', 'upperLimit': '0.80'}]}]}, {'title': 'Desflurane (EndTidal %)', 'denoms': [{'units': 'Participants', 'counts': [{'value': '50', 'groupId': 'OG000'}, {'value': '2', 'groupId': 'OG001'}]}], 'categories': [{'measurements': [{'value': '4.36', 'groupId': 'OG000', 'lowerLimit': '3.40', 'upperLimit': '4.80'}, {'value': '2.33', 'groupId': 'OG001', 'lowerLimit': '1.116', 'upperLimit': '3.49'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Average concentrations of inhalational anesthesia during MAP \\< 60 mmHg episodes', 'unitOfMeasure': 'EndTidal% (other)', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': 'All patients with any MAP \\< 60 mmHg and either a continuous administration of one of the following anesthetics: propofol, sevoflurane, isoflurane, desflurane. On occasion, the anesthesiologist may switch between anesthetic drugs. The numbers analyzed in one or more rows thus does not match the overall number analyzed.'}, {'type': 'SECONDARY', 'title': 'Inhaled Anesthetic Drug Use During Intraoperative Hypotension: MAP < 55 mmHg', 'denoms': [{'units': 'Participants', 'counts': [{'value': '8254', 'groupId': 'OG000'}, {'value': '2196', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'title': 'Sevoflurane (EndTidal %)', 'denoms': [{'units': 'Participants', 'counts': [{'value': '2551', 'groupId': 'OG000'}, {'value': '706', 'groupId': 'OG001'}]}], 'categories': [{'measurements': [{'value': '1.34', 'groupId': 'OG000', 'lowerLimit': '1.00', 'upperLimit': '1.62'}, {'value': '1.25', 'groupId': 'OG001', 'lowerLimit': '0.94', 'upperLimit': '1.55'}]}]}, {'title': 'Isoflurane (EndTidal %)', 'denoms': [{'units': 'Participants', 'counts': [{'value': '5099', 'groupId': 'OG000'}, {'value': '1294', 'groupId': 'OG001'}]}], 'categories': [{'measurements': [{'value': '0.68', 'groupId': 'OG000', 'lowerLimit': '0.52', 'upperLimit': '0.82'}, {'value': '0.67', 'groupId': 'OG001', 'lowerLimit': '0.52', 'upperLimit': '0.80'}]}]}, {'title': 'Desflurane (EndTidal %)', 'denoms': [{'units': 'Participants', 'counts': [{'value': '31', 'groupId': 'OG000'}, {'value': '1', 'groupId': 'OG001'}]}], 'categories': [{'measurements': [{'value': '4.60', 'groupId': 'OG000', 'lowerLimit': '3.49', 'upperLimit': '4.88'}, {'value': '4.65', 'groupId': 'OG001', 'lowerLimit': '4.65', 'upperLimit': '4.65'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Average concentrations of inhalational anesthesia during MAP \\< 55 mmHg episodes', 'unitOfMeasure': 'EndTidal% (other)', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': 'All patients with any MAP \\< 55 mmHg and either a continuous administration of one of the following anesthetics: propofol, sevoflurane, isoflurane, desflurane. On occasion, the anesthesiologist may switch between anesthetic drugs. The numbers analyzed in one or more rows thus does not match the overall number analyzed.'}, {'type': 'SECONDARY', 'title': 'Inhaled Anesthetic Drug Use During Intraoperative Hypotension: MAP < 50 mmHg', 'denoms': [{'units': 'Participants', 'counts': [{'value': '5135', 'groupId': 'OG000'}, {'value': '1413', 'groupId': 'OG001'}]}], 'groups': [{'id': 'OG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'OG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'classes': [{'title': 'Sevoflurane (EndTidal %)', 'denoms': [{'units': 'Participants', 'counts': [{'value': '902', 'groupId': 'OG000'}, {'value': '400', 'groupId': 'OG001'}]}], 'categories': [{'measurements': [{'value': '1.32', 'groupId': 'OG000', 'lowerLimit': '1.00', 'upperLimit': '1.65'}, {'value': '1.23', 'groupId': 'OG001', 'lowerLimit': '0.89', 'upperLimit': '1.57'}]}]}, {'title': 'Isoflurane (EndTidal %)', 'denoms': [{'units': 'Participants', 'counts': [{'value': '3067', 'groupId': 'OG000'}, {'value': '799', 'groupId': 'OG001'}]}], 'categories': [{'measurements': [{'value': '0.65', 'groupId': 'OG000', 'lowerLimit': '0.50', 'upperLimit': '0.82'}, {'value': '0.65', 'groupId': 'OG001', 'lowerLimit': '0.50', 'upperLimit': '0.80'}]}]}, {'title': 'Desflurane (EndTidal %)', 'denoms': [{'units': 'Participants', 'counts': [{'value': '16', 'groupId': 'OG000'}, {'value': '1', 'groupId': 'OG001'}]}], 'categories': [{'measurements': [{'value': '4.28', 'groupId': 'OG000', 'lowerLimit': '3.61', 'upperLimit': '4.78'}, {'value': '4.70', 'groupId': 'OG001', 'lowerLimit': '4.70', 'upperLimit': '4.70'}]}]}], 'paramType': 'MEDIAN', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Average concentrations of inhalational anesthesia during MAP \\< 50 mmHg episodes', 'unitOfMeasure': 'EndTidal% (other)', 'dispersionType': 'Inter-Quartile Range', 'reportingStatus': 'POSTED', 'populationDescription': 'All patients with any MAP \\< 50 mmHg and a continuous administration of one of the following anesthetics: propofol, sevoflurane, isoflurane, desflurane. On occasion, the anesthesiologist may switch between anesthetic drugs. The numbers analyzed in one or more rows thus does not match the overall number analyzed.'}]}, 'participantFlowModule': {'groups': [{'id': 'FG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'FG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}], 'periods': [{'title': 'Historic Cohort - Three Years', 'milestones': [{'type': 'STARTED', 'achievements': [{'groupId': 'FG000', 'numSubjects': '17463'}, {'groupId': 'FG001', 'numSubjects': '0'}]}, {'type': 'MAP < 65 mmHg: Primary Analysis', 'comment': 'Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis.', 'achievements': [{'groupId': 'FG000', 'numSubjects': '15624'}, {'groupId': 'FG001', 'numSubjects': '0'}]}, {'type': 'COMPLETED', 'achievements': [{'groupId': 'FG000', 'numSubjects': '17463'}, {'groupId': 'FG001', 'numSubjects': '0'}]}, {'type': 'NOT COMPLETED', 'achievements': [{'groupId': 'FG000', 'numSubjects': '0'}, {'groupId': 'FG001', 'numSubjects': '0'}]}]}, {'title': 'Month 1: Attending Randomization', 'milestones': [{'type': 'STARTED', 'achievements': [{'groupId': 'FG000', 'numSubjects': '0'}, {'groupId': 'FG001', 'numSubjects': '485'}]}, {'type': 'MAP < 65 mmHg: Primary Analysis', 'comment': 'Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis.', 'achievements': [{'groupId': 'FG000', 'numSubjects': '0'}, {'groupId': 'FG001', 'numSubjects': '432'}]}, {'type': 'Correct IOH Notifications', 'comment': 'The decision support notifications log matches the actual occurrens of intraoperative hypotension.', 'achievements': [{'groupId': 'FG000', 'numSubjects': '0'}, {'groupId': 'FG001', 'numSubjects': '313'}]}, {'type': 'COMPLETED', 'achievements': [{'groupId': 'FG000', 'numSubjects': '0'}, {'groupId': 'FG001', 'numSubjects': '485'}]}, {'type': 'NOT COMPLETED', 'achievements': [{'groupId': 'FG000', 'numSubjects': '0'}, {'groupId': 'FG001', 'numSubjects': '0'}]}]}, {'title': 'Months 2-3: In-room Providers Randomized', 'milestones': [{'type': 'STARTED', 'achievements': [{'groupId': 'FG000', 'numSubjects': '0'}, {'groupId': 'FG001', 'numSubjects': '1253'}]}, {'type': 'MAP < 65 mmHg: Primary Analysis', 'comment': 'Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis.', 'achievements': [{'groupId': 'FG000', 'numSubjects': '0'}, {'groupId': 'FG001', 'numSubjects': '1103'}]}, {'type': 'Correct IOH Notifications', 'comment': 'The decision support notifications log matches the actual occurrens of intraoperative hypotension.', 'achievements': [{'groupId': 'FG000', 'numSubjects': '0'}, {'groupId': 'FG001', 'numSubjects': '825'}]}, {'type': 'COMPLETED', 'achievements': [{'groupId': 'FG000', 'numSubjects': '0'}, {'groupId': 'FG001', 'numSubjects': '1253'}]}, {'type': 'NOT COMPLETED', 'achievements': [{'groupId': 'FG000', 'numSubjects': '0'}, {'groupId': 'FG001', 'numSubjects': '0'}]}]}, {'title': 'Through End of Study: All Interventions', 'milestones': [{'type': 'STARTED', 'achievements': [{'groupId': 'FG000', 'numSubjects': '0'}, {'groupId': 'FG001', 'numSubjects': '3234'}]}, {'type': 'MAP < 65 mmHg: Primary Analysis', 'comment': 'Per study protocol only patients with any MAP \\< 65 mmHg will be included in the primary analysis.', 'achievements': [{'groupId': 'FG000', 'numSubjects': '0'}, {'groupId': 'FG001', 'numSubjects': '2793'}]}, {'type': 'Correct IOH Notifications', 'comment': 'The decision support notifications log matches the actual occurrens of intraoperative hypotension.', 'achievements': [{'groupId': 'FG000', 'numSubjects': '0'}, {'groupId': 'FG001', 'numSubjects': '2072'}]}, {'type': 'COMPLETED', 'achievements': [{'groupId': 'FG000', 'numSubjects': '0'}, {'groupId': 'FG001', 'numSubjects': '3234'}]}, {'type': 'NOT COMPLETED', 'achievements': [{'groupId': 'FG000', 'numSubjects': '0'}, {'groupId': 'FG001', 'numSubjects': '0'}]}]}]}, 'baselineCharacteristicsModule': {'denoms': [{'units': 'Participants', 'counts': [{'value': '17463', 'groupId': 'BG000'}, {'value': '4972', 'groupId': 'BG001'}, {'value': '22435', 'groupId': 'BG002'}]}], 'groups': [{'id': 'BG000', 'title': 'Usual Care Group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm)."}, {'id': 'BG001', 'title': 'Hypotension Decision Support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.'}, {'id': 'BG002', 'title': 'Total', 'description': 'Total of all reporting groups'}], 'measures': [{'title': 'Age, Continuous', 'classes': [{'denoms': [{'units': 'Participants', 'counts': [{'value': '17463', 'groupId': 'BG000'}, {'value': '4972', 'groupId': 'BG001'}, {'value': '22435', 'groupId': 'BG002'}]}], 'categories': [{'measurements': [{'value': '68', 'groupId': 'BG000', 'lowerLimit': '64', 'upperLimit': '74'}, {'value': '68', 'groupId': 'BG001', 'lowerLimit': '64', 'upperLimit': '74'}, {'value': '68', 'groupId': 'BG002', 'lowerLimit': '64', 'upperLimit': '74'}]}]}], 'paramType': 'MEDIAN', 'unitOfMeasure': 'years', 'dispersionType': 'INTER_QUARTILE_RANGE'}, {'title': 'Sex: Female, Male', 'classes': [{'denoms': [{'units': 'Participants', 'counts': [{'value': '17438', 'groupId': 'BG000'}, {'value': '4963', 'groupId': 'BG001'}, {'value': '22401', 'groupId': 'BG002'}]}], 'categories': [{'title': 'Female', 'measurements': [{'value': '7731', 'groupId': 'BG000'}, {'value': '2141', 'groupId': 'BG001'}, {'value': '9872', 'groupId': 'BG002'}]}, {'title': 'Male', 'measurements': [{'value': '9707', 'groupId': 'BG000'}, {'value': '2822', 'groupId': 'BG001'}, {'value': '12529', 'groupId': 'BG002'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'unitOfMeasure': 'Participants', 'populationDescription': 'Incomplete patient demographics section resulted in a row population difference from the Overall.'}, {'title': 'Race (NIH/OMB)', 'classes': [{'denoms': [{'units': 'Participants', 'counts': [{'value': '17463', 'groupId': 'BG000'}, {'value': '4972', 'groupId': 'BG001'}, {'value': '22435', 'groupId': 'BG002'}]}], 'categories': [{'title': 'American Indian or Alaska Native', 'measurements': [{'value': '18', 'groupId': 'BG000'}, {'value': '4', 'groupId': 'BG001'}, {'value': '22', 'groupId': 'BG002'}]}, {'title': 'Asian', 'measurements': [{'value': '113', 'groupId': 'BG000'}, {'value': '36', 'groupId': 'BG001'}, {'value': '149', 'groupId': 'BG002'}]}, {'title': 'Native Hawaiian or Other Pacific Islander', 'measurements': [{'value': '0', 'groupId': 'BG000'}, {'value': '0', 'groupId': 'BG001'}, {'value': '0', 'groupId': 'BG002'}]}, {'title': 'Black or African American', 'measurements': [{'value': '1111', 'groupId': 'BG000'}, {'value': '380', 'groupId': 'BG001'}, {'value': '1491', 'groupId': 'BG002'}]}, {'title': 'White', 'measurements': [{'value': '15571', 'groupId': 'BG000'}, {'value': '4348', 'groupId': 'BG001'}, {'value': '19919', 'groupId': 'BG002'}]}, {'title': 'More than one race', 'measurements': [{'value': '0', 'groupId': 'BG000'}, {'value': '0', 'groupId': 'BG001'}, {'value': '0', 'groupId': 'BG002'}]}, {'title': 'Unknown or Not Reported', 'measurements': [{'value': '650', 'groupId': 'BG000'}, {'value': '204', 'groupId': 'BG001'}, {'value': '854', 'groupId': 'BG002'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'unitOfMeasure': 'Participants'}, {'title': 'Region of Enrollment', 'classes': [{'title': 'United States', 'denoms': [{'units': 'Participants', 'counts': [{'value': '17463', 'groupId': 'BG000'}, {'value': '4972', 'groupId': 'BG001'}, {'value': '22435', 'groupId': 'BG002'}]}], 'categories': [{'measurements': [{'value': '17463', 'groupId': 'BG000'}, {'value': '4972', 'groupId': 'BG001'}, {'value': '22435', 'groupId': 'BG002'}]}]}], 'paramType': 'NUMBER', 'unitOfMeasure': 'participants'}, {'title': 'Body Mass Index', 'classes': [{'denoms': [{'units': 'Participants', 'counts': [{'value': '17306', 'groupId': 'BG000'}, {'value': '4930', 'groupId': 'BG001'}, {'value': '22236', 'groupId': 'BG002'}]}], 'categories': [{'measurements': [{'value': '28', 'groupId': 'BG000', 'lowerLimit': '24', 'upperLimit': '32'}, {'value': '28', 'groupId': 'BG001', 'lowerLimit': '24', 'upperLimit': '32'}, {'value': '28', 'groupId': 'BG002', 'lowerLimit': '24', 'upperLimit': '32'}]}]}], 'paramType': 'MEDIAN', 'description': 'Body Mass Index (BMI) in kg/m\\^2', 'unitOfMeasure': 'kg/m^2', 'dispersionType': 'INTER_QUARTILE_RANGE', 'populationDescription': 'Incorrect demographics data resulted in row population differences from overall.'}, {'title': 'ASA Class', 'classes': [{'denoms': [{'units': 'Participants', 'counts': [{'value': '17463', 'groupId': 'BG000'}, {'value': '4972', 'groupId': 'BG001'}, {'value': '22435', 'groupId': 'BG002'}]}], 'categories': [{'title': 'ASA Class 1', 'measurements': [{'value': '74', 'groupId': 'BG000'}, {'value': '16', 'groupId': 'BG001'}, {'value': '90', 'groupId': 'BG002'}]}, {'title': 'ASA Class 2', 'measurements': [{'value': '3109', 'groupId': 'BG000'}, {'value': '765', 'groupId': 'BG001'}, {'value': '3874', 'groupId': 'BG002'}]}, {'title': 'ASA Class 3', 'measurements': [{'value': '12344', 'groupId': 'BG000'}, {'value': '3578', 'groupId': 'BG001'}, {'value': '15922', 'groupId': 'BG002'}]}, {'title': 'ASA Class 4', 'measurements': [{'value': '1885', 'groupId': 'BG000'}, {'value': '585', 'groupId': 'BG001'}, {'value': '2470', 'groupId': 'BG002'}]}, {'title': 'ASA Class 5', 'measurements': [{'value': '51', 'groupId': 'BG000'}, {'value': '28', 'groupId': 'BG001'}, {'value': '79', 'groupId': 'BG002'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'description': 'The ASA (American Society of Anesthesilogists) physical status classification system is a system for assessing the fitness of patients before surgery. This is assessed by the attending anesthesiologist and is recorded on the preprocedure anesthesia evaluation. ASA Class I corresponds to a healthy patient; ASA Class 2 corresponds to a patient with mild systemic disease; ASA Class 3 is a patient with severe systemic disease; ASA Class 4 a patient with severe systemic disease that is a constant threat to life; ASA Class 5 is a moribund patient who is not expected to survive without the operation.', 'unitOfMeasure': 'Participants'}, {'title': 'Hypertension', 'classes': [{'denoms': [{'units': 'Participants', 'counts': [{'value': '15718', 'groupId': 'BG000'}, {'value': '4500', 'groupId': 'BG001'}, {'value': '20218', 'groupId': 'BG002'}]}], 'categories': [{'measurements': [{'value': '11403', 'groupId': 'BG000'}, {'value': '3348', 'groupId': 'BG001'}, {'value': '14751', 'groupId': 'BG002'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'description': 'Comorbidities present at baseline: essential hypertension', 'unitOfMeasure': 'Participants', 'populationDescription': 'No preoperative data on comorbidities was available in a structured form, resulting in missings.'}, {'title': 'Cardiac disease', 'classes': [{'denoms': [{'units': 'Participants', 'counts': [{'value': '15718', 'groupId': 'BG000'}, {'value': '4500', 'groupId': 'BG001'}, {'value': '20218', 'groupId': 'BG002'}]}], 'categories': [{'measurements': [{'value': '4843', 'groupId': 'BG000'}, {'value': '1489', 'groupId': 'BG001'}, {'value': '6332', 'groupId': 'BG002'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'description': 'Comorbidities present at baseline: cardiac disease (cardiac arrythmia, congestive heart failure, valvular heart disease)', 'unitOfMeasure': 'Participants', 'populationDescription': 'No preoperative data on comorbidities was available in a structured form, resulting in missings.'}, {'title': 'Renal Disease', 'classes': [{'denoms': [{'units': 'Participants', 'counts': [{'value': '15718', 'groupId': 'BG000'}, {'value': '4500', 'groupId': 'BG001'}, {'value': '20218', 'groupId': 'BG002'}]}], 'categories': [{'measurements': [{'value': '1432', 'groupId': 'BG000'}, {'value': '511', 'groupId': 'BG001'}, {'value': '1943', 'groupId': 'BG002'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'description': 'Comorbidities present at baseline: renal disease (non-endstage renal failure)', 'unitOfMeasure': 'Participants', 'populationDescription': 'No preoperative data on comorbidities was available in a structured form, resulting in missings.'}, {'title': 'Peripheral vascular disease', 'classes': [{'denoms': [{'units': 'Participants', 'counts': [{'value': '15718', 'groupId': 'BG000'}, {'value': '4500', 'groupId': 'BG001'}, {'value': '20218', 'groupId': 'BG002'}]}], 'categories': [{'measurements': [{'value': '1947', 'groupId': 'BG000'}, {'value': '596', 'groupId': 'BG001'}, {'value': '2543', 'groupId': 'BG002'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'description': 'Comorbidities present at baseline: peripheral vascular disease', 'unitOfMeasure': 'Participants', 'populationDescription': 'No preoperative data on comorbidities was available in a structured form, resulting in missings.'}, {'title': 'Diabetes Mellitus', 'classes': [{'denoms': [{'units': 'Participants', 'counts': [{'value': '15718', 'groupId': 'BG000'}, {'value': '4500', 'groupId': 'BG001'}, {'value': '20218', 'groupId': 'BG002'}]}], 'categories': [{'measurements': [{'value': '4456', 'groupId': 'BG000'}, {'value': '1296', 'groupId': 'BG001'}, {'value': '5752', 'groupId': 'BG002'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'description': 'Comorbidities present at baseline: diabetes mellitus (any type)', 'unitOfMeasure': 'Participants', 'populationDescription': 'No preoperative data on comorbidities was available in a structured form, resulting in missings.'}, {'title': 'Type of anesthesia', 'classes': [{'denoms': [{'units': 'Participants', 'counts': [{'value': '17463', 'groupId': 'BG000'}, {'value': '4972', 'groupId': 'BG001'}, {'value': '22435', 'groupId': 'BG002'}]}], 'categories': [{'title': 'General anesthesia', 'measurements': [{'value': '17051', 'groupId': 'BG000'}, {'value': '4750', 'groupId': 'BG001'}, {'value': '21801', 'groupId': 'BG002'}]}, {'title': 'Central neuraxial anesthesia', 'measurements': [{'value': '412', 'groupId': 'BG000'}, {'value': '222', 'groupId': 'BG001'}, {'value': '634', 'groupId': 'BG002'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'unitOfMeasure': 'Participants'}, {'title': 'Procedure urgency', 'classes': [{'denoms': [{'units': 'Participants', 'counts': [{'value': '17463', 'groupId': 'BG000'}, {'value': '4972', 'groupId': 'BG001'}, {'value': '22435', 'groupId': 'BG002'}]}], 'categories': [{'title': 'Elective surgery', 'measurements': [{'value': '16452', 'groupId': 'BG000'}, {'value': '4631', 'groupId': 'BG001'}, {'value': '21083', 'groupId': 'BG002'}]}, {'title': 'Emergency surgery', 'measurements': [{'value': '1011', 'groupId': 'BG000'}, {'value': '341', 'groupId': 'BG001'}, {'value': '1352', 'groupId': 'BG002'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'unitOfMeasure': 'Participants'}, {'title': 'Procedure duration', 'classes': [{'denoms': [{'units': 'Participants', 'counts': [{'value': '17463', 'groupId': 'BG000'}, {'value': '4972', 'groupId': 'BG001'}, {'value': '22435', 'groupId': 'BG002'}]}], 'categories': [{'measurements': [{'value': '201', 'groupId': 'BG000', 'lowerLimit': '144', 'upperLimit': '281'}, {'value': '196', 'groupId': 'BG001', 'lowerLimit': '143', 'upperLimit': '271'}, {'value': '200', 'groupId': 'BG002', 'lowerLimit': '144', 'upperLimit': '278'}]}]}], 'paramType': 'MEDIAN', 'description': 'Duration of the procedure in minutes.', 'unitOfMeasure': 'minutes', 'dispersionType': 'INTER_QUARTILE_RANGE'}, {'title': 'Surgical service', 'classes': [{'denoms': [{'units': 'Participants', 'counts': [{'value': '17463', 'groupId': 'BG000'}, {'value': '4972', 'groupId': 'BG001'}, {'value': '22435', 'groupId': 'BG002'}]}], 'categories': [{'title': 'ENT', 'measurements': [{'value': '1891', 'groupId': 'BG000'}, {'value': '528', 'groupId': 'BG001'}, {'value': '2419', 'groupId': 'BG002'}]}, {'title': 'Gynecology', 'measurements': [{'value': '113', 'groupId': 'BG000'}, {'value': '30', 'groupId': 'BG001'}, {'value': '143', 'groupId': 'BG002'}]}, {'title': 'General surgery', 'measurements': [{'value': '3638', 'groupId': 'BG000'}, {'value': '1001', 'groupId': 'BG001'}, {'value': '4639', 'groupId': 'BG002'}]}, {'title': 'Neurosurgery', 'measurements': [{'value': '2138', 'groupId': 'BG000'}, {'value': '622', 'groupId': 'BG001'}, {'value': '2760', 'groupId': 'BG002'}]}, {'title': 'Orthopedic surgery', 'measurements': [{'value': '4283', 'groupId': 'BG000'}, {'value': '1222', 'groupId': 'BG001'}, {'value': '5505', 'groupId': 'BG002'}]}, {'title': 'Plastic surgery', 'measurements': [{'value': '776', 'groupId': 'BG000'}, {'value': '195', 'groupId': 'BG001'}, {'value': '971', 'groupId': 'BG002'}]}, {'title': 'Thoracic surgery', 'measurements': [{'value': '1056', 'groupId': 'BG000'}, {'value': '310', 'groupId': 'BG001'}, {'value': '1366', 'groupId': 'BG002'}]}, {'title': 'Urology', 'measurements': [{'value': '2648', 'groupId': 'BG000'}, {'value': '778', 'groupId': 'BG001'}, {'value': '3426', 'groupId': 'BG002'}]}, {'title': 'Vascular surgery', 'measurements': [{'value': '920', 'groupId': 'BG000'}, {'value': '286', 'groupId': 'BG001'}, {'value': '1206', 'groupId': 'BG002'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'description': 'Surgical specialty of the primary surgeon', 'unitOfMeasure': 'Participants'}, {'title': 'AKI risk based on IOH depth and duration', 'classes': [{'denoms': [{'units': 'Participants', 'counts': [{'value': '17463', 'groupId': 'BG000'}, {'value': '4972', 'groupId': 'BG001'}, {'value': '22435', 'groupId': 'BG002'}]}], 'categories': [{'title': 'AKI risk: none', 'measurements': [{'value': '3684', 'groupId': 'BG000'}, {'value': '1174', 'groupId': 'BG001'}, {'value': '4858', 'groupId': 'BG002'}]}, {'title': 'AKI risk: mild', 'measurements': [{'value': '6622', 'groupId': 'BG000'}, {'value': '1985', 'groupId': 'BG001'}, {'value': '8607', 'groupId': 'BG002'}]}, {'title': 'AKI risk: moderate', 'measurements': [{'value': '4290', 'groupId': 'BG000'}, {'value': '1136', 'groupId': 'BG001'}, {'value': '5426', 'groupId': 'BG002'}]}, {'title': 'AKI risk: high', 'measurements': [{'value': '2867', 'groupId': 'BG000'}, {'value': '677', 'groupId': 'BG001'}, {'value': '3544', 'groupId': 'BG002'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'description': 'Risk of Acute Kidney Injury based on the depth and duration of intraoperative hypotension as defined in the present study.', 'unitOfMeasure': 'Participants'}], 'populationDescription': "Baseline analysis based on the 'Completed' number of patients from the Participant Flow (including patients who did not have any mean arterial pressure \\< 65 mmHg). The 'Hypotension decision support' arm summarizes the last three periods from the Participant Flow section (the intervention periods)."}}, 'documentSection': {'largeDocumentModule': {'largeDocs': [{'date': '2018-12-04', 'size': 1126250, 'label': 'Study Protocol and Statistical Analysis Plan', 'hasIcf': False, 'hasSap': True, 'filename': 'Prot_SAP_000.pdf', 'typeAbbrev': 'Prot_SAP', 'uploadDate': '2018-12-28T09:46', 'hasProtocol': True}]}}, 'protocolSection': {'designModule': {'phases': ['NA'], 'studyType': 'INTERVENTIONAL', 'designInfo': {'allocation': 'NON_RANDOMIZED', 'maskingInfo': {'masking': 'NONE'}, 'primaryPurpose': 'PREVENTION', 'interventionModel': 'SEQUENTIAL', 'interventionModelDescription': 'It is an interrupted time-series of a decision support package intervention that aims to study the the effect of the decision support package on patient outcome. The effects of the individual decision support components of the package on healthcare provider behavior will be studied in a nested cluster-randomized trial: in the first month the attending anesthesiologists will be randomized to near-realtime notifications or feedback emails; in the second month in-room providers will be randomized to near-realtime notifications or feedback emails. Starting month four all providers will receive both near-realtime notifications and feedback emails.'}, 'enrollmentInfo': {'type': 'ACTUAL', 'count': 22435}}, 'statusModule': {'overallStatus': 'COMPLETED', 'startDateStruct': {'date': '2017-01-05', 'type': 'ACTUAL'}, 'expandedAccessInfo': {'hasExpandedAccess': False}, 'statusVerifiedDate': '2019-04', 'completionDateStruct': {'date': '2018-12-29', 'type': 'ACTUAL'}, 'lastUpdateSubmitDate': '2019-04-24', 'studyFirstSubmitDate': '2016-03-28', 'resultsFirstSubmitDate': '2018-12-29', 'studyFirstSubmitQcDate': '2016-03-28', 'lastUpdatePostDateStruct': {'date': '2019-05-16', 'type': 'ACTUAL'}, 'resultsFirstSubmitQcDate': '2019-04-24', 'studyFirstPostDateStruct': {'date': '2016-04-04', 'type': 'ESTIMATED'}, 'resultsFirstPostDateStruct': {'date': '2019-05-16', 'type': 'ACTUAL'}, 'primaryCompletionDateStruct': {'date': '2017-12-31', 'type': 'ACTUAL'}}, 'outcomesModule': {'primaryOutcomes': [{'measure': 'Postoperative Acute Kidney Injury', 'timeFrame': 'Within 7 days after surgery', 'description': "Postoperative Acute Kidney Injury (AKI), Stage I or higher according to the KDIGO criteria (Kidney Disease: Improving Global Outcomes). The staging will be based on serum creatinine values, as documentation of urine output is probably not sufficiently accurate. This will be the primary outcome for the Vanderbilt University Medical Center. The creatinine measurements are part of routine clinical care. Therefore, absence of creatinine postoperative measurements are considered to be 'no suspicion of kidney injury'. KDIGO defines AKI as any of the following: Increase in serum creatinine by 0.3mg/dL or more within 48 hours or Increase in serum creatinine to 1.5 times baseline or more within the last 7 days or Urine output less than 0.5 mL/kg/h for 6 hours. Stage 1 is 1.5-9x baseline or \\>0.3 increase; Stage 2 is 2-2.9x baseline; Stage 3 is 3x baseline, or increase to \\> 4, or initiation of renal replacement therapy."}], 'secondaryOutcomes': [{'measure': '30-day Mortality', 'timeFrame': '30 days after surgery', 'description': "Vanderbilt University Medical Center: combination of in-hospital mortality and 'alive-index' (which checks for visits to the hospital in the electronic healthcare record as indication of being alive at 30 days)"}, {'measure': 'In-hospital Mortality', 'timeFrame': 'All postoperative days during a single hospital admission, expected median of 5 days', 'description': 'Hospital mortality rate during a single hospital admission after the surgery'}, {'measure': 'Postoperative Acute Kidney Injury Stage 2', 'timeFrame': 'Within 7 days after surgery', 'description': "Postoperative Acute Kidney Injury (AKI), Stage II or higher according to the KDIGO criteria (Kidney Disease: Improving Global Outcomes). The staging will be based on serum creatinine values, as documentation of urine output is probably not sufficiently accurate. The creatinine measurements are part of routine clinical care. Therefore, absence of creatinine postoperative measurements are considered to be 'no suspicion of kidney injury'. KDIGO defines AKI as any of the following: Increase in serum creatinine by 0.3mg/dL or more within 48 hours or Increase in serum creatinine to 1.5 times baseline or more within the last 7 days or Urine output less than 0.5 mL/kg/h for 6 hours. Stage 1 is 1.5-9x baseline or \\>0.3 increase; Stage 2 is 2-2.9x baseline; Stage 3 is 3x baseline, or increase to \\> 4, or initiation of renal replacement therapy."}, {'measure': 'Postoperative Rise in Creatinine Levels', 'timeFrame': 'Within 7 days after surgery', 'description': 'Absolute values for serum creatinine before and after surgery will be compared. When multiple postoperative creatinine measurements are made, the maximum difference is reported.'}, {'measure': 'Incidence of a MAP < 60 mmHg', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Incidence of a mean arterial pressure (MAP) \\< 60 mmHg during anesthesia for 1 minute or more.'}, {'measure': 'Incidence of a MAP < 55 mmHg', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Incidence of a mean arterial pressure (MAP) \\< 55 mmHg during anesthesia for 1 minute or more.'}, {'measure': 'Incidence of a MAP < 50 mmHg', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Incidence of a mean arterial pressure (MAP) \\< 50 mmHg during anesthesia for 1 minute or more.'}, {'measure': 'Incidence of a MAP < 60 mmHg for > 10 Minutes', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Incidence of a mean arterial pressure (MAP) \\< 60 mmHg for a cumulative duration of all hypotensive episodes of more than 10 minutes during the anesthetic phase of the procedure.'}, {'measure': 'Incidence of a MAP < 55 mmHg for > 10 Minutes', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Incidence of a mean arterial pressure (MAP) \\< 55 mmHg for a cumulative duration of all hypotensive episodes of more than 10 minutes during the anesthetic phase of the procedure.'}, {'measure': 'Incidence of a MAP < 50 mmHg for > 10 Minutes', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Incidence of a mean arterial pressure (MAP) \\< 50 mmHg for a cumulative duration of all hypotensive episodes of more than 10 minutes during the anesthetic phase of the procedure.'}, {'measure': 'Incidence of a MAP < 60 mmHg for > 20 Minutes', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Incidence of a mean arterial pressure (MAP) \\< 60 mmHg for a cumulative duration of all hypotensive episodes of more than 20 minutes during the anesthetic phase of the procedure.'}, {'measure': 'Incidence of a MAP < 55 mmHg for > 20 Minutes', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Incidence of a mean arterial pressure (MAP) \\< 55 mmHg for a cumulative duration of all hypotensive episodes of more than 20 minutes during the anesthetic phase of the procedure.'}, {'measure': 'Incidence of a MAP < 50 mmHg for > 20 Minutes', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Incidence of a mean arterial pressure (MAP) \\< 50 mmHg for a cumulative duration of all hypotensive episodes of more than 20 minutes during the anesthetic phase of the procedure.'}, {'measure': 'Depth and Duration of Intraoperative Hypotension - Threshold MAP 75 mmHg', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Depth and duration of intraoperative hypotension will be modeled by calculating areas under the threshold for mean arterial pressures (MAPs). Thresholds will vary from 75 mmHg to 50 mmHg in 5 mmHg decrements. Together these variables represent the depth and duration of intraoperative hypotension. To optimize goodness of fit of these variables, the decremental steps may be increased to 10 mmHg and more restrictive lowest and highest thresholds may be chosen for the statistical analysis.'}, {'measure': 'Depth and Duration of Intraoperative Hypotension - Threshold MAP 70 mmHg', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Depth and duration of intraoperative hypotension will be modeled by calculating areas under the threshold for mean arterial pressures (MAPs). Thresholds will vary from 75 mmHg to 50 mmHg in 5 mmHg decrements. Together these variables represent the depth and duration of intraoperative hypotension. To optimize goodness of fit of these variables, the decremental steps may be increased to 10 mmHg and more restrictive lowest and highest thresholds may be chosen for the statistical analysis.'}, {'measure': 'Depth and Duration of Intraoperative Hypotension - Threshold MAP 65 mmHg', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Depth and duration of intraoperative hypotension will be modeled by calculating areas under the threshold for mean arterial pressures (MAPs). Thresholds will vary from 75 mmHg to 50 mmHg in 5 mmHg decrements. Together these variables represent the depth and duration of intraoperative hypotension. To optimize goodness of fit of these variables, the decremental steps may be increased to 10 mmHg and more restrictive lowest and highest thresholds may be chosen for the statistical analysis.'}, {'measure': 'Depth and Duration of Intraoperative Hypotension - Threshold MAP 60 mmHg', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Depth and duration of intraoperative hypotension will be modeled by calculating areas under the threshold for mean arterial pressures (MAPs). Thresholds will vary from 75 mmHg to 50 mmHg in 5 mmHg decrements. Together these variables represent the depth and duration of intraoperative hypotension. To optimize goodness of fit of these variables, the decremental steps may be increased to 10 mmHg and more restrictive lowest and highest thresholds may be chosen for the statistical analysis.'}, {'measure': 'Depth and Duration of Intraoperative Hypotension - Threshold MAP 55 mmHg', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Depth and duration of intraoperative hypotension will be modeled by calculating areas under the threshold for mean arterial pressures (MAPs). Thresholds will vary from 75 mmHg to 50 mmHg in 5 mmHg decrements. Together these variables represent the depth and duration of intraoperative hypotension. To optimize goodness of fit of these variables, the decremental steps may be increased to 10 mmHg and more restrictive lowest and highest thresholds may be chosen for the statistical analysis.'}, {'measure': 'Depth and Duration of Intraoperative Hypotension - Threshold MAP 50 mmHg', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Depth and duration of intraoperative hypotension will be modeled by calculating areas under the threshold for mean arterial pressures (MAPs). Thresholds will vary from 75 mmHg to 50 mmHg in 5 mmHg decrements. Together these variables represent the depth and duration of intraoperative hypotension. To optimize goodness of fit of these variables, the decremental steps may be increased to 10 mmHg and more restrictive lowest and highest thresholds may be chosen for the statistical analysis.'}, {'measure': 'Estimated Intraoperative Blood Loss', 'timeFrame': 'During the surgical procedure: an expected average of 2 hours', 'description': 'The estimated blood loss in mL during the surgical procedure'}, {'measure': 'Time to Discharge Readiness at the Postanesthesia Care Unit (PACU)', 'timeFrame': 'A specific time frame on the day of surgery: from the start of admission to the PACU to discharge from the PACU, an expected average of 4 hours', 'description': 'The time from arriving at the postanesthesia care unit (PACU) until the time the patient is considered ready for discharge (in minutes).'}, {'measure': 'Intravenous Anesthetic Drug Use During Intraoperative Hypotension: MAP < 65 mmHg', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Average concentrations of propofol infusion rates during MAP \\< 65 mmHg episodes'}, {'measure': 'Intravenous Anesthetic Drug Use During Intraoperative Hypotension: MAP < 60 mmHg', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Average concentrations of propofol infusion rates during MAP \\< 60 mmHg episodes'}, {'measure': 'Intravenous Anesthetic Drug Use During Intraoperative Hypotension: MAP < 55 mmHg', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Average concentrations of propofol infusion rates during MAP \\< 55 mmHg episodes'}, {'measure': 'Intravenous Anesthetic Drug Use During Intraoperative Hypotension: MAP < 50 mmHg', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Average concentrations of propofol infusion rates during MAP \\< 50 mmHg episodes'}, {'measure': 'Average Use of Cardiovascular Drugs: Ephedrine', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Average use for each drug will be calculated. Cardiovascular drugs that were given in \\<1% of cases are not reported, as the average dosages would be meaningless.'}, {'measure': 'Average Use of Cardiovascular Drugs: Phenylephrine', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Average use for each drug will be calculated. Cardiovascular drugs that were given in \\<1% of cases are not reported, as the average dosage would be meaningless.'}, {'measure': 'Average Use of Cardiovascular Drugs: Glycopyrrolate', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Average use for each drug will be calculated. Cardiovascular drugs that were given in \\<1% of cases are not reported, as the average dosage would be meaningless.'}, {'measure': 'Average Use of Cardiovascular Drugs: Epinephrine', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Average use for each drug will be calculated. Cardiovascular drugs that were given in \\<1% of cases are not reported, as the average dosage would be meaningless.'}, {'measure': 'Average Use of Cardiovascular Drugs: Norepinephrine', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Average use for each drug will be calculated. Cardiovascular drugs that were given in \\<1% of cases are not reported, as the average dosage would be meaningless.'}, {'measure': 'Timing of Cardiovascular Drugs for MAP < 65 mmHg', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Time of first administration of cardiovascular drug relative to the time at which the mean arterial pressure (MAP) drops below 60 mmHg. Per patient the average time to first administration of all hypotensive episodes was calculated. That average time is used as the outcome variable. A negative value indicates that administration occurred before the drop in MAP.'}, {'measure': 'Timing of Cardiovascular Drugs for MAP < 60 mmHg', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Time of first administration of cardiovascular drug relative to the time at which the mean arterial pressure (MAP) drops below 60 mmHg. Per patient the average time to first administration of all hypotensive episodes was calculated. That average time is used as the outcome variable. A negative value indicates that administration occurred before the drop in MAP.'}, {'measure': 'Timing of Cardiovascular Drugs for MAP < 55 mmHg', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Time of first administration of cardiovascular drug relative to the time at which the mean arterial pressure (MAP) drops below 55 mmHg. Per patient the average time to first administration of all hypotensive episodes was calculated. That average time is used as the outcome variable. A negative value indicates that administration occurred before the drop in MAP.'}, {'measure': 'Timing of Cardiovascular Drugs for MAP < 50 mmHg', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Cardiovascular drugs as defined under interventions. Time of first administration of cardiovascular drug relative to the time at which the mean arterial pressure (MAP) drops below 50 mmHg. Per patient the average time to first administration of all hypotensive episodes was calculated. That average time is used as the outcome variable. A negative value indicates that administration occurred before the drop in MAP.'}, {'measure': 'Intraoperative Administration of Intravenous Fluids', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Total amount (mL) of intravenous fluids (as defined under interventions) administered during the surgical procedure.'}, {'measure': 'Inhaled Anesthetic Drug Use During Intraoperative Hypotension: MAP < 65 mmHg', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Average concentrations of inhalational anesthesia during MAP \\< 65 mmHg episodes'}, {'measure': 'Inhaled Anesthetic Drug Use During Intraoperative Hypotension: MAP < 60 mmHg', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Average concentrations of inhalational anesthesia during MAP \\< 60 mmHg episodes'}, {'measure': 'Inhaled Anesthetic Drug Use During Intraoperative Hypotension: MAP < 55 mmHg', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Average concentrations of inhalational anesthesia during MAP \\< 55 mmHg episodes'}, {'measure': 'Inhaled Anesthetic Drug Use During Intraoperative Hypotension: MAP < 50 mmHg', 'timeFrame': 'During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours', 'description': 'Average concentrations of inhalational anesthesia during MAP \\< 50 mmHg episodes'}]}, 'oversightModule': {'oversightHasDmc': False}, 'conditionsModule': {'keywords': ['Decision support', 'Decision Support Systems, Clinical', 'Decision Support Techniques', 'Hypotension', 'Intraoperative Hypotension', 'Acute Kidney Injury', 'Postoperative Mortality', 'Blood Pressure'], 'conditions': ['Hypotension']}, 'descriptionModule': {'briefSummary': 'The purpose of this study is to determine whether a decision support system can improve the adherence to thresholds for low blood pressure by anesthesia providers, which in turn prevents their patients from having organ injury.', 'detailedDescription': "Blood pressure management is an important part of anesthesia. Many factors contribute to a change in blood pressure during a surgical procedure, such as blood loss, manipulation by surgeons, and there are several mechanisms through which anesthesia itself changes blood pressure. Although a high blood pressure also occurs during anesthesia, most of these factors lower a patient's blood pressure. When a patient's blood pressure becomes too low, the internal organs become at risk of receiving not enough blood (low perfusion or hypoperfusion). This low perfusion state can result in organ damage (ischemia) because of an insufficient supply of oxygen and glucose. Hence the important task of anesthesia providers to maintain the blood pressure of patients, using a wide range of drugs and other interventions.\n\nA big challenge in blood pressure management is to know when a low blood pressure indeed results in low perfusion of organs. There is a large variation between patients in how susceptible they are to low blood pressure, as well as a difference between the organs in how easily they are damaged because of low perfusion. Elder patients, or patients with preexisting hypertension, heart problems or other cardiovascular diseases are more prone to a low blood pressure and are more likely to develop organ ischemia when there is a low blood pressure. The kidneys, the heart and the brain are the organs that are most at risk of organ damage. As one cannot measure the perfusion states of individual organs in individual patients, it is very difficult to know 'how low to go' with a patient's blood pressure.\n\nRecent studies have used large datasets of patients to demonstrate that there is statistical association between low blood pressure during surgery and various types of organ injury. As patients are already treated for low blood pressure by anesthesia providers, this suggests that patients have low organ perfusion states despite the current treatment standards. A patient's blood pressure is not simply a dial that can be adjusted to a specific level. Finding the right level of interventions can be difficult in some patients. Consequently, lower blood pressures are common in anesthesia, even with the current standards of blood pressure management.\n\nIn this proposed study the investigators will implement two forms of decision support to assist anesthesia providers in blood pressure management. The decision support aims to educate anesthesia providers about the risks of low blood pressures in direct relation to the patients that they treat. One form of decision support will provide automated notifications through pagers and through the anesthesia information management system. These automated notifications pop up when the patient's blood pressure drops below a level that is associated with a risk of organ injury, and thus alerts the anesthesia provider of the blood pressure and its associated risk. The second form of decision support will send a postoperative email the day after the procedure when the patient has had a low blood pressure for particular duration. This email then provides feedback to the anesthesia provider by informing them of the increased risks of organ injury that are associated with that low blood pressure.\n\nThe study will look at both a change in patient outcome and a change in blood pressure management and will be performed at the Vanderbilt University Medical Center (VUMC). The change in patient outcome will primarily be studied through the occurrence of acute kidney injury in the first days following the procedure at the VUMC. The change in blood pressure management (provider behavior) will be studied by observing the depth and duration of low pressures during anesthesia, and the number of interventions that have been used to treat the blood pressure. Patient outcome will be studied by comparison of a baseline phase - before the decision support is implemented and uses historic data- and the intervention phase - the period during which the intervention is active. Only routinely collected clinical data will be used for these analyses: no additional data collection is required.\n\nAs it is impossible to know which form of decision support will be the most effective, the first three months of the intervention period will be a 'nested cluster-randomized trial'. The anesthesia providers (not the patients) will be randomized to either the automated notifications or the feedback emails. After three months all anesthesia providers will receive both forms of decision support for the remainder of the intervention period. The reason why anesthesia providers are randomized only during the first three months is that cross-over or contamination between the two groups is expected. This contamination could make it impossible to study the effect of the decision support on patient outcome, as there will be no longer any difference between the study groups."}, 'eligibilityModule': {'sex': 'ALL', 'stdAges': ['ADULT', 'OLDER_ADULT'], 'maximumAge': '100 Years', 'minimumAge': '60 Years', 'healthyVolunteers': False, 'eligibilityCriteria': 'Inclusion Criteria:\n\n* 60 years and older\n* Inpatients\n* Scheduled for a non-cardiac surgical procedure under general or central neuraxial anesthesia\n\nExclusion Criteria:\n\n* Pre-existing end-stage renal disease: operationalized as a preoperative need for dialysis\n* The following surgical procedures: renal surgery, cardiac surgery, organ transplantation, ophthalmic surgery, endoscopic gastrointestinal procedures, and (interventional) radiologic procedures.\n* small non-invasive or minimally-invasive procedures will also be excluded, operationalized as excluding procedures with a surgical time of less than twenty minutes.'}, 'identificationModule': {'nctId': 'NCT02726620', 'briefTitle': 'Decision Support for Intraoperative Low Blood Pressure', 'organization': {'class': 'OTHER', 'fullName': 'Vanderbilt University Medical Center'}, 'officialTitle': 'Decision Support for Intraoperative Low Blood Pressure', 'orgStudyIdInfo': {'id': '160131'}}, 'armsInterventionsModule': {'armGroups': [{'type': 'EXPERIMENTAL', 'label': 'Hypotension decision support', 'description': 'The intervention period. Several decision support elements are implemented to notify anesthesia providers: attending anesthesiologists and in-room anesthesia providers of intraoperative hypotension (threshold of a mean arterial pressure below 60 mmHg). Two types of decision support will be implemented: near real-time decision support and feedback emails.\n\nNear real-time decision support elements will notify the anesthesia providers of a blood pressure drop below the threshold and display the associated increased risk of acute kidney injury. The notification is presented through the pager system for attending anesthesiologists and through the anesthesia information management system for the in-room anesthesia provider.\n\nAll providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension that is associated with an increased risk of organ injury due to organ ischemia.', 'interventionNames': ['Procedure: Attending real-time decision support', 'Procedure: In-room real-time decision support', 'Procedure: Attending feedback emails', 'Procedure: In-room provider feedback emails', 'Device: Anesthesia Information Management System (AIMS)', 'Device: Perioperative Data Warehouse (PDW)', 'Procedure: General anesthesia', 'Device: Pager system', 'Procedure: Central neuraxial anesthesia', 'Procedure: Non-cardiac surgery', 'Drug: Propofol', 'Drug: Sevoflurane', 'Drug: Desflurane', 'Drug: Isoflurane', 'Drug: Ephedrine', 'Drug: Phenylephrine', 'Drug: Norepinephrine', 'Drug: Epinephrine', 'Drug: Dobutamine', 'Drug: Dopamine', 'Drug: Isoproterenol', 'Drug: Milrinone', 'Drug: Atropine', 'Drug: Glycopyrrolate', 'Drug: Vasopressin', 'Drug: Terlipressin', 'Drug: Sodium Chloride 0.9%', "Drug: Ringer's lactate", 'Drug: Hydroxyethyl starch solutions', 'Drug: Fresh Frozen Plasma', 'Drug: Packed Red Blood Cells', 'Drug: Albumin solutions', 'Drug: Plasma-Lyte', 'Drug: Lidocaine', 'Drug: Bupivacaine', 'Drug: Levobupivacaine', 'Drug: Ropivacaine', 'Drug: Mepivacaine', 'Drug: Tetracaine', 'Drug: Prilocaine', 'Drug: Procaine', 'Drug: Chloroprocaine', 'Drug: Benzocaine', 'Drug: Articaine']}, {'type': 'ACTIVE_COMPARATOR', 'label': 'Usual care group', 'description': "The 'before' period - or historic control group - during which no decision support for intraoperative hypotension was being used, also known as 'usual care'. This is the three year period prior to the intervention period (the 'Intraoperative hypotension decision support' arm).", 'interventionNames': ['Procedure: General anesthesia', 'Procedure: Central neuraxial anesthesia', 'Procedure: Non-cardiac surgery', 'Drug: Propofol', 'Drug: Sevoflurane', 'Drug: Desflurane', 'Drug: Isoflurane', 'Drug: Ephedrine', 'Drug: Phenylephrine', 'Drug: Norepinephrine', 'Drug: Epinephrine', 'Drug: Dobutamine', 'Drug: Dopamine', 'Drug: Isoproterenol', 'Drug: Milrinone', 'Drug: Atropine', 'Drug: Glycopyrrolate', 'Drug: Vasopressin', 'Drug: Terlipressin', 'Drug: Sodium Chloride 0.9%', "Drug: Ringer's lactate", 'Drug: Hydroxyethyl starch solutions', 'Drug: Fresh Frozen Plasma', 'Drug: Packed Red Blood Cells', 'Drug: Albumin solutions', 'Drug: Plasma-Lyte', 'Drug: Lidocaine', 'Drug: Bupivacaine', 'Drug: Levobupivacaine', 'Drug: Ropivacaine', 'Drug: Mepivacaine', 'Drug: Tetracaine', 'Drug: Prilocaine', 'Drug: Procaine', 'Drug: Chloroprocaine', 'Drug: Benzocaine', 'Drug: Articaine']}], 'interventions': [{'name': 'Attending real-time decision support', 'type': 'PROCEDURE', 'description': 'Near real-time decision support elements will notify the attending anesthesiologists of a blood pressure drop below the threshold for intraoperative hypotension (mean arterial pressure below 60 mmHg). The notification is presented through the pager system. The page will also display the associated increased risk of organ injury due to organ ischemia.', 'armGroupLabels': ['Hypotension decision support']}, {'name': 'In-room real-time decision support', 'type': 'PROCEDURE', 'description': 'Near real-time decision support elements will notify the in-room anesthesia provider of a blood pressure drop below the threshold for intraoperative hypotension (mean arterial pressure below 60 mmHg). The notification is presented through the anesthesia information management system. The decision support system will display the associated increased risk of organ injury due to organ ischemia.', 'armGroupLabels': ['Hypotension decision support']}, {'name': 'Attending feedback emails', 'type': 'PROCEDURE', 'description': 'Attending anesthesiologists will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension (mean arterial pressure below 60 mmHg or lower for a particular duration) that is associated with an increased risk of organ injury due to organ ischemia.', 'armGroupLabels': ['Hypotension decision support']}, {'name': 'In-room provider feedback emails', 'type': 'PROCEDURE', 'description': 'In-room anesthesia providers will be notified through email within 24 hours after the end of an anesthetic case, when the patient had an episode of intraoperative hypotension (mean arterial pressure below 60 mmHg or lower for a particular duration) that is associated with an increased risk of organ injury due to organ ischemia.', 'armGroupLabels': ['Hypotension decision support']}, {'name': 'Anesthesia Information Management System (AIMS)', 'type': 'DEVICE', 'description': 'The anesthesia electronic record keeping system', 'armGroupLabels': ['Hypotension decision support']}, {'name': 'Perioperative Data Warehouse (PDW)', 'type': 'DEVICE', 'description': 'The data warehouse that is used to gather perioperative data and create user reports. In this instance the PDW will be used to send the postoperative feedback emails.', 'armGroupLabels': ['Hypotension decision support']}, {'name': 'General anesthesia', 'type': 'PROCEDURE', 'description': 'Any anesthetic drugs that are used to induce general anesthesia above the level of sedation.', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Pager system', 'type': 'DEVICE', 'description': 'The mobile pager system through which alerts can be sent', 'armGroupLabels': ['Hypotension decision support']}, {'name': 'Central neuraxial anesthesia', 'type': 'PROCEDURE', 'otherNames': ['Regional anesthesia', 'Spinal anesthesia', 'Intrathecal anesthesia', 'Subarachnoid anesthesia', 'Epidural anesthesia', 'Central neuraxial blockade'], 'description': 'Regional anesthesia effectuated through the placement of local anesthetics around the nerves of the central nervous system, e.g. spinal anesthesia and epidural anesthesia.', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Non-cardiac surgery', 'type': 'PROCEDURE', 'description': 'Any surgical intervention that is not aimed at surgical correction of the heart', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Propofol', 'type': 'DRUG', 'description': 'Anesthetic drug used to maintain general anesthesia', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Sevoflurane', 'type': 'DRUG', 'description': 'Anesthetic drug used to maintain general anesthesia', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Desflurane', 'type': 'DRUG', 'description': 'Anesthetic drug used to maintain general anesthesia', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Isoflurane', 'type': 'DRUG', 'description': 'Anesthetic drug used to maintain general anesthesia', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Ephedrine', 'type': 'DRUG', 'description': 'Cardiovascular drug used to treat intraoperative hypotension', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Phenylephrine', 'type': 'DRUG', 'description': 'Cardiovascular drug used to treat intraoperative hypotension', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Norepinephrine', 'type': 'DRUG', 'description': 'Cardiovascular drug used to treat intraoperative hypotension', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Epinephrine', 'type': 'DRUG', 'description': 'Cardiovascular drug used to treat intraoperative hypotension', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Dobutamine', 'type': 'DRUG', 'description': 'Cardiovascular drug used to treat intraoperative hypotension', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Dopamine', 'type': 'DRUG', 'description': 'Cardiovascular drug used to treat intraoperative hypotension', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Isoproterenol', 'type': 'DRUG', 'description': 'Cardiovascular drug used to treat intraoperative hypotension', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Milrinone', 'type': 'DRUG', 'description': 'Cardiovascular drug used to treat intraoperative hypotension', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Atropine', 'type': 'DRUG', 'description': 'Cardiovascular drugs used to treat intraoperative hypotension', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Glycopyrrolate', 'type': 'DRUG', 'description': 'Cardiovascular drug used to treat intraoperative hypotension', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Vasopressin', 'type': 'DRUG', 'description': 'Cardiovascular drug used to treat intraoperative hypotension', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Terlipressin', 'type': 'DRUG', 'description': 'Cardiovascular drug used to treat intraoperative hypotension', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Sodium Chloride 0.9%', 'type': 'DRUG', 'description': 'Intravenous fluid used to treat intraoperative hypotension', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': "Ringer's lactate", 'type': 'DRUG', 'description': 'Intravenous fluid used to treat intraoperative hypotension', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Hydroxyethyl starch solutions', 'type': 'DRUG', 'description': 'Intravenous fluid used to treat intraoperative hypotension', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Fresh Frozen Plasma', 'type': 'DRUG', 'description': 'Intravenous fluid used to treat intraoperative hypotension', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Packed Red Blood Cells', 'type': 'DRUG', 'description': 'Intravenous fluid used to treat intraoperative hypotension', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Albumin solutions', 'type': 'DRUG', 'description': 'Intravenous fluid used to treat intraoperative hypotension', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Plasma-Lyte', 'type': 'DRUG', 'description': 'Intravenous fluid used to treat intraoperative hypotension', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Lidocaine', 'type': 'DRUG', 'otherNames': ['Lignocaine'], 'description': 'Local anesthetic used for central neuraxial anesthesia.', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Bupivacaine', 'type': 'DRUG', 'description': 'Local anesthetic used for central neuraxial anesthesia.', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Levobupivacaine', 'type': 'DRUG', 'description': 'Local anesthetic used for central neuraxial anesthesia.', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Ropivacaine', 'type': 'DRUG', 'description': 'Local anesthetic used for central neuraxial anesthesia.', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Mepivacaine', 'type': 'DRUG', 'description': 'Local anesthetic used for central neuraxial anesthesia.', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Tetracaine', 'type': 'DRUG', 'description': 'Local anesthetic used for central neuraxial anesthesia.', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Prilocaine', 'type': 'DRUG', 'description': 'Local anesthetic used for central neuraxial anesthesia.', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Procaine', 'type': 'DRUG', 'description': 'Local anesthetic used for central neuraxial anesthesia.', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Chloroprocaine', 'type': 'DRUG', 'description': 'Local anesthetic used for central neuraxial anesthesia.', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Benzocaine', 'type': 'DRUG', 'description': 'Local anesthetic used for central neuraxial anesthesia.', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}, {'name': 'Articaine', 'type': 'DRUG', 'description': 'Local anesthetic used for central neuraxial anesthesia.', 'armGroupLabels': ['Hypotension decision support', 'Usual care group']}]}, 'contactsLocationsModule': {'locations': [{'zip': '37212', 'city': 'Nashville', 'state': 'Tennessee', 'country': 'United States', 'facility': 'Vanderbilt University Medical Center', 'geoPoint': {'lat': 36.16589, 'lon': -86.78444}}], 'overallOfficials': [{'name': 'Jonathan P Wanderer, MD, MPhil', 'role': 'PRINCIPAL_INVESTIGATOR', 'affiliation': 'Vanderbilt University Medical Center, Department of Anesthesiology'}]}, 'ipdSharingStatementModule': {'ipdSharing': 'NO'}, 'sponsorCollaboratorsModule': {'leadSponsor': {'name': 'Vanderbilt University Medical Center', 'class': 'OTHER'}, 'collaborators': [{'name': 'UMC Utrecht', 'class': 'OTHER'}], 'responsibleParty': {'type': 'PRINCIPAL_INVESTIGATOR', 'investigatorTitle': 'Medical Director of Procedure Preparation Center', 'investigatorFullName': 'Jonathan Wanderer', 'investigatorAffiliation': 'Vanderbilt University Medical Center'}}}}