Background: 

We report adherence to 6 Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) quality metrics (QMs) relevant to patients undergoing decompressive craniectomy or endoscopic clot evacuation after spontaneous supratentorial intracerebral hemorrhage (sICH).

Methods: 

In this retrospective observational study, we describe adherence to the following ASPIRE QMs: acute kidney injury (AKI-01); mean arterial pressure < 65 mm Hg for less than 15 minutes (BP-03); myocardial injury (CARD-02); treatment of high glucose (> 200 mg/dL, GLU-03); reversal of neuromuscular blockade (NMB-02); and perioperative hypothermia (TEMP-03).

Result: 

The study included 95 patients (70% male) with median (interquartile range) age 55 (47 to 66) years and ICH score 2 (1 to 3) undergoing craniectomy (n=55) or endoscopic clot evacuation (n=40) after sICH. In-hospital mortality attributable to sICH was 23% (n=22). Patients with American Society of Anesthesiologists physical status class 5 (n=16), preoperative reduced glomerular filtration rate (n=5), elevated cardiac troponin (n=21) and no intraoperative labs with high glucose (n=71), those who were not extubated at the end of the case (n=62) or did not receive a neuromuscular blocker given (n=3), and patients having emergent surgery (n=64) were excluded from the analysis for their respective ASPIRE QM based on predetermined ASPIRE exclusion criteria. For the remaining patients, the adherence to ASPIRE QMs were: AKI-01, craniectomy 34%, endoscopic clot evacuation 1%; BP-03, craniectomy 72%, clot evacuation 73%; CARD-02, 100% for both groups; GLU-03, craniectomy 67%, clot evacuation 100%; NMB-02, clot evacuation 79%, and; TEMP-03, clot evacuation 0% with hypothermia.

Conclusion: 

This study found variable adherence to ASPIRE QMs in sICH patients undergoing decompressive craniectomy or endoscopic clot evacuation. The relatively high number of patients excluded from individual ASPIRE metrics is a major limitation.

中文翻译：

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自发性幕上脑出血后接受去骨瓣减压术和内窥镜血栓清除术患者的麻醉学绩效改进和报告交换 (ASPIRE) 质量指标：一项回顾性观察研究

背景： 

我们报告遵守与自发性幕上脑出血 (sICH) 后接受去骨瓣减压术或内窥镜血栓清除术的患者相关的 6 麻醉学绩效改进和报告交换 (ASPIRE) 质量指标 (QM)。

方法： 

在这项回顾性观察研究中，我们描述了对以下 ASPIRE QM 的依从性：急性肾损伤 (AKI-01)；平均动脉压 < 65 毫米汞柱少于 15 分钟 (BP-03)；心肌损伤 (CARD-02)；治疗高血糖（> 200 mg/dL，GLU-03）；逆转神经肌肉阻滞 (NMB-02)；和围手术期低温 (TEMP-03)。

结果： 

该研究包括 95 名患者（70% 为男性），中位年龄（四分位间距）为 55 岁（47 至 66 岁）且 ICH 评分为 2 分（1 至 3 分），在术后接受去骨瓣切除术（n=55）或内窥镜血栓清除术（n=40） SICH。归因于 sICH 的院内死亡率为 23% (n=22)。美国麻醉师协会身体状况 5 级 (n=16)、术前肾小球滤过率降低 (n=5)、心肌肌钙蛋白升高 (n=21) 且术中无高血糖 (n=71) 的患者，在病例结束时未拔管 (n=62) 或未接受给予的神经肌肉阻滞剂 (n=3)，并且接受急诊手术的患者 (n=64) 被排除在各自的 ASPIRE QM 分析之外预先确定的 ASPIRE 排除标准。对于其余患者，对 ASPIRE QM 的依从性为：AKI-01，颅骨切除术 34%，内窥镜凝块清除 1%；BP-03，去骨瓣 72%，血块清除 73%；CARD-02，两组均为 100%；GLU-03，去骨瓣 67%，凝块清除 100%；NMB-02，凝块清除率 79%，以及；TEMP-03，低体温凝块排出 0%。

结论： 

本研究发现，在接受去骨瓣减压术或内窥镜血块清除术的 sICH 患者中，对 ASPIRE QM 的依从性存在差异。从个别 ASPIRE 指标中排除的患者数量相对较多是一个主要限制。