Hospital Harm - Postoperative Venous Thromboembolism 1.0.000

The proportion of inpatient encounters for patients age 18 years and older, who have at least one surgical procedure performed inside the operating room during the encounter, and who suffer the harm of a postoperative venous thromboembolism (VTE) during the encounter or within 30 days after the first surgical procedure

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This measure and specifications are subject to further revisions.

This performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications.

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The measure’s initial risk model will include the following factors:

Sex
Age
Bleeding disorders
Cancer
Central venous catheter insertion
History of venous thromboembolism (VTE)
Obesity
Respiratory operations
Stroke
Vascular surgery

In addition to the above risk factors, which are included in the risk model, the measure also captures the following diagnoses and procedures to support the potential modification of the risk adjustment model in future years:

Diabetes
Fractures
Hip/knee replacement
Hormone therapy use
Immobility
Tobacco use

Please see the Hospital Harm – Postoperative Venous Thromboembolism Risk Adjustment Methodology Report on the eCQI Resource Center website: https://ecqi.healthit.gov

In-hospital postoperative venous thromboembolism (VTE) encompasses both deep vein thrombosis (DVTs) and pulmonary embolisms (PEs). DVT is associated with poor clinical outcomes, including post-thrombotic syndrome in the leg, anticoagulation-related bleeding, and death (Bysshe et al., 2017). Even though VTE is linked to adverse patient outcomes, there are evidence-based strategies for preventing VTE in hospital settings.

During 2019, 2021, and 2022, patients in the United States experienced 51,586 perioperative VTEs (AHRQ, 2024). This volume of detected, preventable safety events illustrates that there are continued opportunities to reduce the rate of postoperative VTEs.

In terms of processes of care that clinicians can utilize to prevent these safety events, one study found evidence that combining hospital interventions, such as mechanical and pharmacological prophylaxis, can reduce the incidence of DVT among patients undergoing surgery or admitted with trauma (Kakkos et al., 2022). Another study found that interruptions or delays in the prescription of VTE prophylaxis in surgical patients are associated with a 2- to 3- fold increased risk of VTE (Henke et al., 2020). Furthermore, there are clinical guidelines (noted in the clinical recommendation statement section) to support and improve clinical decision making in the prevention of VTE. As such, hospitals have evidence-based strategies to prevent VTEs in the inpatient setting. These findings suggest that there are opportunities to lower postoperative VTE rates through hospital intervention.

Current clinical practice guidelines recommend the administration of mechanical and/or pharmacologic prophylaxis along with the implementation of a formal strategy within the hospital as appropriate methods to prevent VTE postoperatively.

The American College of Chest Physicians (CHEST) provides the following recommendations as they pertain to general and abdominal-pelvic surgery patients (Gould et al., 2012):

3.6.3. For general and abdominal-pelvic surgery patients at moderate risk for VTE (∼3.0%; Rogers score, > 10; Caprini score, 3-4) who are not at high risk for major bleeding complications, we suggest low-molecular-weight heparin (LMWH) (Grade 2B), low-dose unfractionated heparin (LDUH) (Grade 2B), or mechanical prophylaxis, preferably with IPC (Grade 2C), over no prophylaxis.

3.6.5. For general and abdominal-pelvic surgery patients at high risk for VTE (∼6.0%; Caprini score, ≥ 5) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with LMWH (Grade 1B) or LDUH (Grade 1B) over no prophylaxis. We suggest that mechanical prophylaxis with elastic stockings (ES) or IPC should be added to pharmacologic prophylaxis (Grade 2C).

CHEST provides the following recommendation as it pertains to cardiac surgery patients (Gould et al., 2012):

4.4.2 For cardiac surgery patients whose hospital course is prolonged by one or more no hemorrhagic surgical complications, we suggest adding pharmacologic prophylaxis with LDUH or LMWH to mechanical prophylaxis (Grade 2C).

CHEST provides the following recommendation as it pertains to thoracic surgery patients (Gould et al., 2012):

5.4.2 For thoracic surgery patients at high risk for VTE who are not at high risk for perioperative bleeding, we suggest LDUH or LMWH over no prophylaxis (Grade 1C).

CHEST provides the following recommendation as it pertains to craniotomy patients (Gould et al., 2012):

6.4.2 For craniotomy patients at very high risk for VTE (e.g., those undergoing craniotomy for malignant disease), we suggest adding pharmacologic prophylaxis to mechanical prophylaxis once adequate hemostasis is established and the risk of bleeding decreases (Grade 2C).

CHEST provides the following recommendation as it pertains to spinal surgery patients (Gould et al., 2012):

7.4.2 For patients undergoing spinal surgery at high risk for VTE (including those with malignant disease or those undergoing surgery with a combined anterior-posterior approach), we suggest adding pharmacologic prophylaxis to mechanical prophylaxis once adequate hemostasis is established and the risk of bleeding decreases (Grade 2C).

The American Society of Hematology (ASH) provides the following guidelines (Anderson et al., 2019): Recommendation 4. For patients undergoing major surgery who receive pharmacologic prophylaxis, the ASH guideline panel suggests using combined prophylaxis with mechanical and pharmacological methods over prophylaxis with pharmacological agents alone.

Recommendation 5. For patients undergoing major surgery, the ASH guideline panel suggests depending on the individual patient and the type of surgical procedure, using combined prophylaxis or mechanical prophylaxis alone.

Recommendation 6. For patients undergoing major surgery, the ASH guideline panel suggests against using inferior vena cava (IVC) filters for prophylaxis of VTE.

Recommendation 10. In patients undergoing total hip or total knee arthroplasty, conditional recommendations included using either aspirin or anticoagulants, as well as for a direct oral anticoagulant over low-molecular-weight heparin (LMWH).

Decreased score indicates improvement

Reference Type: Citation

Reference Text:

Agency for Healthcare Research and Quality. (2024). AHRQ PSI technical documentation (Version v2024). Rockville, MD: Author. https://qualityindicators.ahrq.gov/measures/psi_resources

Reference Type: Citation

Reference Text:

Anderson, D. R., Morgano, G. P., Bennett, C., Dentali, F., Francis, C. W., Garcia, D. A., Kahn, S. R., Rahman, M., Rajasekhar, A., Rogers, F. B., Smythe, M. A., Tikkinen, K. A. O., Yates, A. J., Baldeh, T., Balduzzi, S., Brożek, J. L., Ikobaltzeta, I. E., Johal, H., Neumann, I., … Dahm, P. (2019). American Society of Hematology 2019 guidelines for management of venous thromboembolism: Prevention of venous thromboembolism in surgical hospitalized patients. Blood Advances, 3(23), 3898–3944. https://doi.org/10.1182/bloodadvances.2019000975

Reference Type: Citation

Reference Text:

Bartlett, M. A., Mauck, K. F., Stephenson, C. R., Ganesh, R., & Daniels, P. R. (2020). Perioperative venous thromboembolism prophylaxis. Mayo Clinic Proceedings, 95(12), 2775–2798. https://doi.org/10.1016/j.mayocp.2020.06.015

Reference Type: Citation

Reference Text:

Bysshe, T., Gao, Y., Heaney-Huls, K., Hockenberry, J., Hovey, L., Laffan, A. M., Lee, S., Murphy, D. J., & Watts, E. (2017). Estimating the additional hospital inpatient cost and mortality associated with selected hospital-acquired conditions. Agency for Healthcare Research and Quality. https://www.norc.org/content/dam/norc-org/documents/standard-projects-pdf/hac-cost-report2017.pdf

Reference Type: Citation

Reference Text:

Centers for Medicare & Medicaid Services. (2024). Quality in motion: Acting on the CMS national quality strategy. https://www.cms.gov/files/document/quality-motion-cms-national-quality-strategy.pdf

Reference Type: Citation

Reference Text:

Gould, M. K., Garcia, D. A., Wren, S. M., Karanicolas, P. J., Arcelus, J. I., Heit, J. A., & Samama, C. M. (2012). Prevention of VTE in nonorthopedic surgical patients: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2), e227S–e277S. https://doi.org/10.1378/chest.11-2297

Reference Type: Citation

Reference Text:

Hanley, M., Steigner, M. L., Ahmed, O., Azene, E. M., Bennett, S. J., Chandra, A., Desjardins, B., Gage, K. L., Ginsburg, M., Mauro, D., Oliva, I. B., Ptak, T., Strax, R., Verma, N., & Dill, K. E. (2018). American College of Radiology ACR Appropriateness Criteria®: Suspected lower extremity deep vein thrombosis. American College of Radiology. https://acsearch.acr.org/docs/69416/Narrative

Reference Type: Citation

Reference Text:

Henke, P. K., Kahn, S. R., Pannucci, C. J., Secemsky, E. A., Evans, N. S., Khorana, A. A., Creager, M. A., & Pradhan, A. D. (2020). Call to action to prevent venous thromboembolism in hospitalized patients: A policy statement from the American Heart Association. Circulation, 141(24), e914–e931. https://doi.org/10.1161/cir.0000000000000769

Reference Type: Citation

Reference Text:

Kakkos, S., Kirkilesis, G., Caprini, J. A., Geroulakos, G., Nicolaides, A., Stansby, G., & Reddy, D. J. (2022). Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism. Cochrane Database of Systematic Reviews, 2022(1), CD005258. https://doi.org/10.1002/14651858.CD005258.pub4

Reference Type: Citation

Reference Text:

Key, N. S., Khorana, A. A., Kuderer, N. M., Bohlke, K., Lee, A. Y. Y., Arcelus, J. I., Wong, S. L., Balaban, E. P., Flowers, C. R., Gates, L. E., Kakkar, A. K., Tempero, M. A., Gupta, S., Lyman, G. H., & Falanga, A. (2023). Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO guideline update. Journal of Clinical Oncology, 41(16), 3063–3071. https://doi.org/10.1200/JCO.23.00294

Reference Type: Citation

Reference Text:

Konstantinides, S. V., Meyer, G., Bueno, H., et al. (2020). 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). European Heart Journal, 41(4), 543–603. https://doi.org/10.1093/eurheartj/ehz405

Reference Type: Citation

Reference Text:

National Institute for Health and Care Excellence. (2020). Venous thromboembolic diseases: Diagnosis, management and thrombophilia testing (NICE guideline NG158). https://www.nice.org.uk/guidance/ng158

Reference Type: Citation

Reference Text:

Stevens, S. M., Woller, S. C., Baumann Kreuziger, L., Doerschug, K., Geersing, G. J., Klok, F. A., King, C. S., Murin, S., Vintch, J. R. E., Wells, P. S., Wasan, S., & Moores, L. K. (2024). Antithrombotic therapy for VTE disease: Compendium and review of CHEST guidelines 2012–2021. Chest, 166(2), 388–404. https://doi.org/10.1016/j.chest.2024.03.003

Reference Type: Citation

Reference Text:

Stevens, S. M., Woller, S. C., Kreuziger, L. B., Bounameaux, H., Doerschug, K., Geersing, G.-J., Huisman, M. V., Kearon, C., King, C. S., Knighton, A. J., Lake, E., Murin, S., Vintch, J. R. E., Wells, P. S., & Moores, L. K. (2021). Antithrombotic therapy for VTE disease. Chest, 160(6), e545–e608. https://doi.org/10.1016/j.chest.2021.07.055

Inpatient encounters: Includes time in the emergency department, observation, and/or outpatient surgery service when the transition between discharge from these encounters and admission to the inpatient encounter is one hour or less.

Surgical procedures: The combined concepts of anesthesia data AND operating room location are used to determine if a surgical procedure occurred. Patients are admitted to the operating room location for any surgical procedure. Using these combined concepts identifies patients at higher risk of developing a postoperative venous thromboembolism (VTE).

First surgical procedure: The first surgical procedure occurring during the inpatient encounter. The measure is specified to assess whether a VTE occurred within 30 days following the first surgical procedure.

Qualifying inpatient encounter: The inpatient encounter that qualifies a patient for the measure denominator. The measure identifies whether a VTE occurs within 30 days of the first surgical procedure that occurs during this qualifying inpatient encounter. Criteria A and B identify instances when that post-operative VTE occurs during the qualifying inpatient encounter, and Criteria C identifies instances when that post-operative VTE occurs during a subsequent encounter, but all of these criteria limit their scope to VTEs occurring within the 30-day window following the first surgical procedure of the qualifying inpatient encounter.

Subsequent encounter: An inpatient encounter occurring within 30 days of the first surgical procedure of the qualifying inpatient encounter. If a patient experiences a VTE during this encounter as defined by numerator Criteria C, the qualifying inpatient encounter is included in the measure numerator. If a subsequent encounter qualifies the preceding qualifying inpatient encounter for inclusion in the measure numerator, then the subsequent encounter cannot qualify as a qualifying inpatient encounter, even if it otherwise satisfies the measure denominator criteria.

A postoperative VTE is defined as a pulmonary embolism (PE) or lower extremity deep vein thrombosis (DVT) experienced by postoperative patients within 30 days following their first surgical procedure. The measure uses four methods to detect a postoperative VTE event, three of which occur within the qualifying inpatient encounter and the fourth occurs in a subsequent encounter. These methods include (1) the use of a diagnostic imaging study and administration of anticoagulants, (2) placement of inferior vena cava filter, (3) diagnosis of VTE not present on admission, or (4) a VTE diagnosed and administration of anticoagulation therapy during a subsequent encounter.

To reduce sensitivity to overdiagnosis bias, diagnosis codes for distal (calf) vein thromboses, solitary subsegmental pulmonary emboli, and unspecified VTE diagnosis codes are not considered as a qualifying VTE diagnosis. The American College of Radiology Expert Panel on Vascular Imaging states, “DVT that is limited to the infrapopliteal calf veins (i.e., below-the-knee or distal DVT) often resolves spontaneously and is rarely associated with pulmonary embolism or other adverse outcome” (Hanley et al., 2018). Similarly, CHEST guidelines state that subsegmental pulmonary emboli is more likely to be a false-positive finding, and clinicians may be safe to refrain from providing anticoagulant therapy if no proximal DVT is present (Stevens et al., 2021).

In Criterion B, due to the risk of bleeding with intracranial or spinal surgeries if VTE prophylaxis is administered, postoperative VTE events will only be considered in the numerator if a diagnostic imaging study is performed after thromboprophylaxis is deemed safe to start which is between 5 days and up to 30 days after the end of the first surgical procedure performed during the qualifying inpatient encounter.

In Criterion C, anticoagulation therapy ordered or prescribed during the subsequent encounter is defined by an anticoagulant medication ordered during the subsequent encounter or an anticoagulant ordered at discharge of the subsequent encounter.

Present on admission (POA) is defined as the conditions present at the time the order for inpatient admission occurs. The POA Indicator is intended to differentiate conditions present at the time of admission from those conditions that develop during the inpatient admission.

A POA Indicator of Y = yes (Diagnosis was present at time of inpatient admission)
A POA Indicator of N = no (Diagnosis was not present at time of inpatient admission)
A POA Indicator of W = clinically undetermined
A POA Indicator of U = documentation insufficient to determine if the condition was present at the time of inpatient admission

Per CMS and the Agency for Healthcare Research and Quality (AHRQ) convention, POA indicators of Y and W are accepted indicators of a diagnosis present on admission. POA indicators of N and U are accepted indicators of a diagnosis that is not present on admission.

The factor "history of venous thromboembolism (VTE)" included in the measure’s initial risk model is defined as a VTE risk assessment completed with a result of high risk during or before the encounter OR if there was a history of VTE as a diagnosis during or before the encounter.

To calculate the observed hospital-level measure result, divide the total numerator events by the total number of denominator eligible inpatient encounters (denominator-denominator exclusions).

To generate the hospital’s risk adjusted rates, CMS uses a regression model to account for sex, age, bleeding disorders, cancer, central venous catheter insertion, history of venous thromboembolism (VTE), obesity, respiratory operations, stroke, and vascular surgery.

Only one harm (numerator event) is counted per qualifying inpatient encounter and within the 30-day evaluation period.

This eCQM is an episode-based measure. An episode is defined as each inpatient encounter that ends during the measurement period.

This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

Inpatient encounters for patients age 18 and older where a surgical procedure was performed inside the operating room during the encounter

Equals Initial Population

Inpatient encounters for

Patient with an obstetric-related diagnosis during the inpatient encounter
Patients with a venous thromboembolism (VTE) diagnosis present on admission
Patients who had extracorporeal membrane oxygenation (ECMO) during the inpatient encounter
Patients with acute brain or spinal injury or hemorrhage present on admission
Patients who had a thrombectomy procedure which occurred before or on the same day as the first surgical procedure during the inpatient encounter
Patients who had intracranial or spinal surgery during the inpatient encounter who were discharged less than 5 days after the end of the surgery
Patients who have a duration of stay less than 2 calendar days

Inpatient encounters for patients with a postoperative venous thromboembolism (VTE) within 30 days of the first surgical procedure.

Evidence of a postoperative VTE is determined by either Criterion A, B or C:

Criterion A: A qualifying inpatient encounter, excluding encounters where the first surgical procedure was an intracranial or spinal surgery procedure, with a diagnostic imaging study performed during the qualifying inpatient encounter and within 30 days or less after the end of the first surgical procedure performed and at least one of the following:

An anticoagulation medication order within 24 hours after the end of the diagnostic imaging study during the qualifying inpatient encounter. An anticoagulation medication order is evidenced by:
- Enoxaparin (Lovenox) >80 mg per day
- Apixaban (Eliquis) >=10 mg per day
- Rivaroxaban (Xarelto) >=20 mg per day
- Fondaparinux (Arixtra) >= 5 mg per day
- Dalteparin sodium (Fragmin)>= 10,000 IU per day; or
A heparin intravenous administration within 24 hours after the end of the diagnostic imaging study, with at least 2 activated partial thromboplastin (aPTT) heparin therapy monitoring tests or at least 2 anti factor Xa assays within 35 hours of the start of heparin intravenous therapy administration all which occur during the qualifying inpatient encounter; or
Placement of an inferior vena cava (IVC) filter within 24 hours after the end of the diagnostic imaging study and during the qualifying inpatient encounter; or
A diagnosis of VTE which was not present on admission during the qualifying inpatient encounter.

Criterion B: A qualifying inpatient encounter, where the first surgical procedure was for an intracranial or spinal surgery, and a diagnostic imaging study was performed during the qualifying inpatient encounter and the diagnostic imagining study occurred between 5 days and up to 30 days after the end of the first surgical procedure and at least one of the following:

An anticoagulation medication order within 24 hours after the end of the diagnostic imaging study during the qualifying inpatient encounter. An anticoagulation medication order is evidenced by:
- Enoxaparin (Lovenox) >80 mg per day
- Apixaban (Eliquis) >=10 mg per day
- Rivaroxaban (Xarelto) >=20 mg per day
- Fondaparinux (Arixtra) >= 5 mg per day
- Dalteparin sodium (Fragmin)>= 10,000 IU per day; or
A heparin intravenous administration within 24 hours after the diagnostic imaging study, with at least 2 aPTT heparin therapy monitoring tests or at least 2 anti factor Xa assays within 35 hours of the start of heparin intravenous therapy administration, all of which occur during the qualifying inpatient encounter; or
Placement of an inferior vena cava (IVC) filter within 24 hours after the end of the diagnostic imaging study and during the qualifying inpatient encounter; or
A diagnosis of VTE which was not present on admission during the qualifying inpatient encounter.

Criterion C: A VTE that occurs during a subsequent inpatient encounter and within 30 days or less after the end of the first surgical procedure that occurred during the qualifying inpatient encounter as evidenced by:

A diagnosis of VTE during the subsequent encounter;

and

Anticoagulation therapy ordered or prescribed during the subsequent encounter.

For every patient evaluated by this measure also identify payer, race, ethnicity, and sex

Initial Population

  "Encounters With Procedure With Anesthesia In The Operating Room"

- Denominator
  - "Initial Population"

Denominator Exclusions

  "Encounters With Surgical Procedure And With Obstetrical Condition"
    union "Encounters With VTE Present On Admission"
    union "Encounters With ECMO Procedure"
    union "Encounters With Acute Brain Or Spinal Injury Or Hemorrhage Present On Admission"
    union "Encounters With Thrombectomy Before Or Same Day As Another Procedure"
    union "Intracranial Or Spinal Surgery Encounters With Discharge Less Than 5 Days After Surgery"
    union "Encounters With Length Of Stay Less Than 2 Days"
    union "Encounter That Is Also A Subsequent VTE Encounter"

Numerator

  "Encounters With PostOp Imaging Study Without Intracranial Or Spinal Surgery With Evidence Of VTE"
    union "Intracranial Or Spinal Surgery Encounters With PostOp Imaging Study With Evidence Of VTE"
    union "Encounters With Subsequent VTE Encounter Within 30 Days PostOp"

- Numerator Exclusions
  - None

- Denominator Exceptions
  - None

- Stratification
  - None

Apixiban Greater Than Or Equal To 10mg Daily

  ["Medication, Order": "Apixaban"] Apixiban
    where Apixiban.dosage >= 10 'mg'
      and Apixiban.frequency ~ "Once daily (qualifier value)"
      or ( Apixiban.dosage >= 5 'mg'
          and Apixiban.frequency ~ "Twice a day (qualifier value)"
      )

Base Qualifying Encounters

  ["Encounter, Performed": "Encounter Inpatient"] InpatientEncounter
    let HospitalizationPeriod:
      Global."HospitalizationWithObservationAndOutpatientSurgeryService"(InpatientEncounter)
    where AgeInYearsAt(date from start of HospitalizationPeriod) >= 18
      and HospitalizationPeriod ends during day of "Measurement Period"
      and not exists (
        InpatientEncounter.diagnoses EncounterDiagnoses
          where EncounterDiagnoses.code in "Obstetrics and VTE Obstetrics"
      )

Dalteparin Greater Than Or Equal To 10,000 IU Daily

  ["Medication, Order": "Dalteparin Anticoagulant"] Dalteparin
    where Dalteparin.dosage.unit = '[IU]'
      and Dalteparin.dosage.value >= 10000
      and Dalteparin.frequency ~ "Once daily (qualifier value)"

Denominator
- - "Initial Population"

Denominator Exclusion

  "Encounters With Surgical Procedure And With Obstetrical Condition"
    union "Encounters With VTE Present On Admission"
    union "Encounters With ECMO Procedure"
    union "Encounters With Acute Brain Or Spinal Injury Or Hemorrhage Present On Admission"
    union "Encounters With Thrombectomy Before Or Same Day As Another Procedure"
    union "Intracranial Or Spinal Surgery Encounters With Discharge Less Than 5 Days After Surgery"
    union "Encounters With Length Of Stay Less Than 2 Days"
    union "Encounter That Is Also A Subsequent VTE Encounter"

Encounter That Is Also A Subsequent VTE Encounter

  "Subsequent Encounters With VTE Within 30 Days PostOp" VTEAttributedEncounter
    with "Initial Population" IndexEncounter
      such that IndexEncounter.id = VTEAttributedEncounter.id

Encounters With Acute Brain Or Spinal Injury Or Hemorrhage Present On Admission

  "Encounters With Procedure With Anesthesia In The Operating Room" InpatientEncounter
    where exists ( InpatientEncounter.diagnoses BrainSpinalInjurydiagnosis
        where BrainSpinalInjurydiagnosis.code in "Acute Brain or Spinal Injury or Hemorrhage"
          and BrainSpinalInjurydiagnosis.presentOnAdmissionIndicator in "Present on Admission or Clinically Undetermined"
    )

Encounters With Age 18 And Older

  ["Encounter, Performed": "Encounter Inpatient"] EncounterIP
    where EncounterIP.relevantPeriod ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterIP.relevantPeriod) >= 18

Encounters With ECMO Procedure

  "Encounters With Procedure With Anesthesia In The Operating Room" InpatientEncounter
    with ["Procedure, Performed": "Extracorporeal Membrane Oxygenation"] ECMO
      such that Global."NormalizeInterval" ( ECMO.relevantDatetime, ECMO.relevantPeriod ) during Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( InpatientEncounter )

Encounters With Length Of Stay Less Than 2 Days

  "Encounters With Procedure With Anesthesia In The Operating Room" InpatientEncounter
      where Global."LengthInDays" ( Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( InpatientEncounter ) ) < 2

Encounters With PostOp Imaging Study And Intravenous Heparin With At Least 2 AntiFactorXa Tests Without Intracranial Or Spinal Surgery

  from
    "Encounters Without Intracranial Or Spinal Surgery With PostOp Imaging Study Within 30 Days After Surgery" QualifyingEncounter,
    "Imaging Study For VTE" ImagingStudy,
    "Intravenous Heparin Administration" IntravenousHeparin
    let
    HospitalizationPeriod: Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter),
    FirstProcedurePeriod: Global."NormalizeInterval"("FirstProcedure"(QualifyingEncounter).relevantDatetime, "FirstProcedure"(QualifyingEncounter).relevantPeriod),
    ImagingPeriod: Global."NormalizeInterval"(ImagingStudy.relevantDatetime, ImagingStudy.relevantPeriod),
    HeparinPeriod: Global."NormalizeInterval"(IntravenousHeparin.relevantDatetime, IntravenousHeparin.relevantPeriod),
    ImagingWindow: Interval[end of FirstProcedurePeriod, end of FirstProcedurePeriod + 30 days]
  where ImagingPeriod starts during HospitalizationPeriod
    and ImagingPeriod starts during ImagingWindow
    and HeparinPeriod starts during HospitalizationPeriod
    and HeparinPeriod starts 24 hours or less after end of ImagingPeriod
    and Count("AntiFactorXaAssayHeparinMonitoringTests"(QualifyingEncounter, IntravenousHeparin)) > 1
  return QualifyingEncounter

Encounters With PostOp Imaging Study And Intravenous Heparin With At Least 2 aPTT Tests Without Intracranial Or Spinal Surgery

  from
    "Encounters Without Intracranial Or Spinal Surgery With PostOp Imaging Study Within 30 Days After Surgery" QualifyingEncounter,
    "Imaging Study For VTE" ImagingStudy,
    "Intravenous Heparin Administration" IntravenousHeparin
    let
    HospitalizationPeriod: Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter),
    FirstProcedurePeriod: Global."NormalizeInterval"("FirstProcedure"(QualifyingEncounter).relevantDatetime, "FirstProcedure"(QualifyingEncounter).relevantPeriod),
    ImagingPeriod: Global."NormalizeInterval"(ImagingStudy.relevantDatetime, ImagingStudy.relevantPeriod),
    HeparinPeriod: Global."NormalizeInterval"(IntravenousHeparin.relevantDatetime, IntravenousHeparin.relevantPeriod),
    ImagingWindow: Interval[end of FirstProcedurePeriod, end of FirstProcedurePeriod + 30 days]
  where ImagingPeriod starts during HospitalizationPeriod
    and ImagingPeriod starts during ImagingWindow
    and HeparinPeriod starts during HospitalizationPeriod
    and HeparinPeriod starts 24 hours or less after end of ImagingPeriod
    and Count("aPTTHeparinMonitoringTests"(QualifyingEncounter, IntravenousHeparin)) > 1
  return QualifyingEncounter

Encounters With PostOp Imaging Study And IVC Filter Placement Without Intracranial Or Spinal Surgery

    from
        "Encounters Without Intracranial Or Spinal Surgery With PostOp Imaging Study Within 30 Days After Surgery" QualifyingEncounter,
        "Imaging Study For VTE" ImagingStudy,
        ["Procedure, Performed": "Inferior Vena Cava (IVC) Filter Placement"] IVCFilterPlacement
      let
        HospitalizationPeriod: Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( QualifyingEncounter ),
        FirstProcedurePeriod: Global."NormalizeInterval" ( "FirstProcedure"(QualifyingEncounter).relevantDatetime, "FirstProcedure"(QualifyingEncounter).relevantPeriod ),
        IVCFilterPlacementTime: Global."NormalizeInterval" ( IVCFilterPlacement.relevantDatetime, IVCFilterPlacement.relevantPeriod ),
        ImagingPeriod: Global."NormalizeInterval" ( ImagingStudy.relevantDatetime, ImagingStudy.relevantPeriod ),
        ImagingWindow: Interval[end of FirstProcedurePeriod, end of FirstProcedurePeriod + 30 days]
      where ImagingPeriod starts during HospitalizationPeriod
        and ImagingPeriod starts during ImagingWindow
        and IVCFilterPlacementTime starts during HospitalizationPeriod
        and IVCFilterPlacementTime starts 24 hours or less after end of ImagingPeriod
    return QualifyingEncounter

Encounters With PostOp Imaging Study And Non Heparin Therapeutic Anticoagulant Without Intracranial Or Spinal Surgery

  from
    "Encounters Without Intracranial Or Spinal Surgery With PostOp Imaging Study Within 30 Days After Surgery" QualifyingEncounter,
    "Imaging Study For VTE" ImagingStudy,
    "Non Heparin Therapeutic Medication Order" Anticoagulant
    let
    HospitalizationPeriod: Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter),
    FirstProcedurePeriod: Global."NormalizeInterval"("FirstProcedure"(QualifyingEncounter).relevantDatetime,"FirstProcedure"(QualifyingEncounter).relevantPeriod),
    ImagingPeriod: Global."NormalizeInterval"(ImagingStudy.relevantDatetime, ImagingStudy.relevantPeriod),
    ImagingWindow: Interval[end of FirstProcedurePeriod, end of FirstProcedurePeriod + 30 days]
  where ImagingPeriod starts during HospitalizationPeriod
    and ImagingPeriod starts during ImagingWindow
    and Anticoagulant.authorDatetime during HospitalizationPeriod
    and Anticoagulant.authorDatetime 24 hours or less after end of ImagingPeriod
  return QualifyingEncounter

Encounters With PostOp Imaging Study And VTE Diagnosis Not Present On Admission Without Intracranial Or Spinal Surgery

  "Encounters Without Intracranial Or Spinal Surgery With PostOp Imaging Study Within 30 Days After Surgery" QualifyingEncounter
    where exists ( QualifyingEncounter.diagnoses VTEDiagnosis
        where VTEDiagnosis.code in "Venous Thromboembolism"
          and (VTEDiagnosis.presentOnAdmissionIndicator in "Not Present On Admission or Documentation Insufficient to Determine" or VTEDiagnosis.presentOnAdmissionIndicator is null)
    )

Encounters With PostOp Imaging Study Within 30 Days Of Surgery

  "Encounters With Procedure With Anesthesia In The Operating Room" InpatientEncounter
    with "Imaging Study For VTE" ImagingStudy
      such that Global."NormalizeInterval" ( ImagingStudy.relevantDatetime, ImagingStudy.relevantPeriod ) during Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( InpatientEncounter )
        and Global."NormalizeInterval" ( ImagingStudy.relevantDatetime, ImagingStudy.relevantPeriod ) starts 30 days or less after end of Global."NormalizeInterval" ( "FirstProcedure"(InpatientEncounter).relevantDatetime, "FirstProcedure"(InpatientEncounter).relevantPeriod )

Encounters With PostOp Imaging Study Without Intracranial Or Spinal Surgery With Evidence Of VTE

  "Encounters With PostOp Imaging Study And Non Heparin Therapeutic Anticoagulant Without Intracranial Or Spinal Surgery"
    union "Encounters With PostOp Imaging Study And Intravenous Heparin With At Least 2 AntiFactorXa Tests Without Intracranial Or Spinal Surgery"
    union "Encounters With PostOp Imaging Study And Intravenous Heparin With At Least 2 aPTT Tests Without Intracranial Or Spinal Surgery"
    union "Encounters With PostOp Imaging Study And IVC Filter Placement Without Intracranial Or Spinal Surgery"
    union "Encounters With PostOp Imaging Study And VTE Diagnosis Not Present On Admission Without Intracranial Or Spinal Surgery"

Encounters With Procedure With Anesthesia In The Operating Room

  "Encounters With Age 18 And Older" AgeEncounter
    with ["Procedure, Performed": "General and Neuraxial Anesthesia"] AnesthesiaProcedure
      such that Global."NormalizeInterval" ( AnesthesiaProcedure.relevantDatetime, AnesthesiaProcedure.relevantPeriod ) during Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( AgeEncounter )
        and exists ( AgeEncounter.facilityLocations EncounterLocation
            where EncounterLocation.code ~ "Operating Room/Suite"
              and Global."NormalizeInterval" ( AnesthesiaProcedure.relevantDatetime, AnesthesiaProcedure.relevantPeriod ) starts during EncounterLocation.locationPeriod
        )

Encounters With Subsequent VTE Encounter Within 30 Days PostOp

  "Encounters With Procedure With Anesthesia In The Operating Room" InpatientEncounter
    with "Subsequent Encounters With VTE Diagnosis And VTE Medication" VTE
      such that VTE.relevantPeriod starts after end of InpatientEncounter.relevantPeriod
        and VTE.relevantPeriod starts 30 days or less after end of Global."NormalizeInterval" ( "FirstProcedure"(InpatientEncounter).relevantDatetime, "FirstProcedure"(InpatientEncounter).relevantPeriod )

Encounters With Surgical Procedure And With Obstetrical Condition

  "Encounters With Procedure With Anesthesia In The Operating Room" EncounterWithSurgery
    where ( exists ( EncounterWithSurgery.diagnoses EncounterDiagnoses
          where EncounterDiagnoses.code in "Obstetrics and VTE Obstetrics"
      )
    )

Encounters With Thrombectomy Before Or Same Day As Another Procedure

  "Encounters With Procedure With Anesthesia In The Operating Room" InpatientEncounter
    with ["Procedure, Performed": "Pulmonary Arterial Thrombectomy"] Thrombectomy
      such that Global."NormalizeInterval" ( Thrombectomy.relevantDatetime, Thrombectomy.relevantPeriod ) during Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( InpatientEncounter )
        and Global."NormalizeInterval" ( Thrombectomy.relevantDatetime, Thrombectomy.relevantPeriod ) starts on or before day of start of Global."NormalizeInterval" ( "FirstProcedure"(InpatientEncounter).relevantDatetime, "FirstProcedure"(InpatientEncounter).relevantPeriod )

Encounters With VTE Present On Admission

  "Encounters With Procedure With Anesthesia In The Operating Room" InpatientEncounter
    where exists ( InpatientEncounter.diagnoses VTEdiagnosis
        where VTEdiagnosis.code in "Venous Thromboembolism"
          and VTEdiagnosis.presentOnAdmissionIndicator in "Present on Admission or Clinically Undetermined"
    )

Encounters Without Intracranial Or Spinal Surgery With PostOp Imaging Study Within 30 Days After Surgery

  "Encounters With PostOp Imaging Study Within 30 Days Of Surgery" ImagingStudyEncounter
    without "Intracranial Or Spinal Surgery Encounter" SurgeryEncounter
      such that SurgeryEncounter.relevantPeriod during ImagingStudyEncounter.relevantPeriod

Enoxaparin Greater Than 80mg Daily

  ["Medication, Order": "Enoxaparin Anticoagulant"] Enoxaparin
    where Enoxaparin.dosage > 40 'mg'
      and Enoxaparin.frequency ~ "Twice a day (qualifier value)"
      or ( Enoxaparin.dosage > 80 'mg'
          and Enoxaparin.frequency ~ "Once daily (qualifier value)"
      )

Fondaparinux Greater Than Or Equal To 5mg Daily

  ["Medication, Order": "Fondaparinux Anticoagulant"] Fondaparinux
    where (Fondaparinux.dosage >= 2.5 'mg'
      and Fondaparinux.frequency ~ "Twice a day (qualifier value)"
      or Fondaparinux.dosage >= 5 'mg'
      and Fondaparinux.frequency ~ "Once daily (qualifier value)")

Has High Risk Indicator For VTE

  exists(["Assessment, Performed": "Risk for venous thromboembolism"] VTERiskAssessment
    with "Initial Population" EncounterIP
        such that VTERiskAssessment.result ~ "High" and
        (Global."EarliestOf" ( VTERiskAssessment.relevantDatetime, VTERiskAssessment.relevantPeriod ) before day of EncounterIP.relevantPeriod
            or Global."EarliestOf" ( VTERiskAssessment.relevantDatetime, VTERiskAssessment.relevantPeriod ) during EncounterIP.relevantPeriod))

Has History Of VTE

    exists("Initial Population" EncounterIP
        where EncounterIP.diagnoses.code contains "Personal history of other venous thrombosis and embolism")

Imaging Study For VTE

  ["Diagnostic Study, Performed": "CT Angiography of Chest"]
    union ["Diagnostic Study, Performed": "Pulmonary Ventilation/Perfusion (VQ) Scan"]
    union ["Diagnostic Study, Performed": "Ultrasound of Lower Extremities"]
    union ["Diagnostic Study, Performed": "Abdominal or Pelvic CT Scan with Contrast"]

Initial Population

  "Encounters With Procedure With Anesthesia In The Operating Room"

Intracranial Or Spinal Surgery

  ["Procedure, Performed": "Intracranial Neurosurgery"]
    union ["Procedure, Performed": "Spinal Surgery"]

Intracranial Or Spinal Surgery Encounter

  "Encounters With Procedure With Anesthesia In The Operating Room" InpatientEncounter
  let 
    HospitalizationPeriod: Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( InpatientEncounter ),
    FirstProcedurePeriod: Global."NormalizeInterval" ( "FirstProcedure"(InpatientEncounter).relevantDatetime, "FirstProcedure"(InpatientEncounter).relevantPeriod )
    with "Intracranial Or Spinal Surgery" BrainSpineSurgery
      such that Global."NormalizeInterval" ( BrainSpineSurgery.relevantDatetime, BrainSpineSurgery.relevantPeriod ) during HospitalizationPeriod
      and Global."NormalizeInterval" ( BrainSpineSurgery.relevantDatetime, BrainSpineSurgery.relevantPeriod ) overlaps FirstProcedurePeriod

Intracranial Or Spinal Surgery Encounters With Discharge Less Than 5 Days After Surgery

  "Encounters With Procedure With Anesthesia In The Operating Room" InpatientEncounter
    with "Intracranial Or Spinal Surgery" BrainSpineSurgery
      such that Global."NormalizeInterval" ( BrainSpineSurgery.relevantDatetime, BrainSpineSurgery.relevantPeriod ) during Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( InpatientEncounter )
        and Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( InpatientEncounter ) ends less than 5 days after end of Global."NormalizeInterval" ( BrainSpineSurgery.relevantDatetime, BrainSpineSurgery.relevantPeriod )

Intracranial Or Spinal Surgery Encounters With PostOp Imaging Study And Intravenous Heparin

  from
    "Intracranial Or Spinal Surgery Encounters With PostOp Imaging Study Between 5 And 30 Days After Surgery" BrainSpinalEncounter,
    "Imaging Study For VTE" ImagingStudy,
    "Intravenous Heparin Administration" IntravenousHeparin
     let
    HospitalizationPeriod: Global."HospitalizationWithObservationAndOutpatientSurgeryService"(BrainSpinalEncounter),
    FirstProcedurePeriod: Global."NormalizeInterval"("FirstProcedure"(BrainSpinalEncounter).relevantDatetime, "FirstProcedure"(BrainSpinalEncounter).relevantPeriod),
    IntravenousHeparinTime: Global."NormalizeInterval"(IntravenousHeparin.relevantDatetime, IntravenousHeparin.relevantPeriod),
    ImagingPeriod: Global."NormalizeInterval"(ImagingStudy.relevantDatetime, ImagingStudy.relevantPeriod),
    ImagingWindow: Interval[end of FirstProcedurePeriod + 5 days, end of FirstProcedurePeriod + 30 days]
  where ImagingPeriod starts during HospitalizationPeriod
    and ImagingPeriod starts during ImagingWindow
    and IntravenousHeparinTime starts during HospitalizationPeriod
    and IntravenousHeparinTime starts 24 hours or less after end of ImagingPeriod
  return BrainSpinalEncounter

Intracranial Or Spinal Surgery Encounters With PostOp Imaging Study And Intravenous Heparin With At Least 2 AntiFactorXa Tests

  "Intracranial Or Spinal Surgery Encounters With PostOp Imaging Study And Intravenous Heparin" SurgicalHeparinEncounter
    where exists (
      from
        "Imaging Study For VTE" ImagingStudy,
        "Intravenous Heparin Administration" IntravenousHeparin
    let
        HospitalizationPeriod: Global."HospitalizationWithObservationAndOutpatientSurgeryService"(SurgicalHeparinEncounter),
        FirstProcedurePeriod: Global."NormalizeInterval"("FirstProcedure"(SurgicalHeparinEncounter).relevantDatetime, "FirstProcedure"(SurgicalHeparinEncounter).relevantPeriod),
        IntravenousHeparinTime: Global."NormalizeInterval"(IntravenousHeparin.relevantDatetime, IntravenousHeparin.relevantPeriod),
        ImagingPeriod: Global."NormalizeInterval"(ImagingStudy.relevantDatetime, ImagingStudy.relevantPeriod),
        ImagingWindow: Interval[end of FirstProcedurePeriod + 5 days, end of FirstProcedurePeriod + 30 days]
      where ImagingPeriod starts during HospitalizationPeriod
        and ImagingPeriod starts during ImagingWindow
        and IntravenousHeparinTime starts during HospitalizationPeriod
        and IntravenousHeparinTime starts 24 hours or less after end of ImagingPeriod
        and ( Count("AntiFactorXaAssayHeparinMonitoringTests"(SurgicalHeparinEncounter, IntravenousHeparin)) > 1 )
      return IntravenousHeparin
    )

Intracranial Or Spinal Surgery Encounters With PostOp Imaging Study And Intravenous Heparin With At Least 2 aPTT Tests

  "Intracranial Or Spinal Surgery Encounters With PostOp Imaging Study And Intravenous Heparin" SurgicalHeparinEncounter
    where exists (
      from
        "Imaging Study For VTE" ImagingStudy,
        "Intravenous Heparin Administration" IntravenousHeparin
      let
        HospitalizationPeriod: Global."HospitalizationWithObservationAndOutpatientSurgeryService"(SurgicalHeparinEncounter),
        FirstProcedurePeriod: Global."NormalizeInterval"("FirstProcedure"(SurgicalHeparinEncounter).relevantDatetime, "FirstProcedure"(SurgicalHeparinEncounter).relevantPeriod),
        IntravenousHeparinTime: Global."NormalizeInterval"(IntravenousHeparin.relevantDatetime, IntravenousHeparin.relevantPeriod),
        ImagingPeriod: Global."NormalizeInterval"(ImagingStudy.relevantDatetime, ImagingStudy.relevantPeriod),
        ImagingWindow: Interval[end of FirstProcedurePeriod + 5 days, end of FirstProcedurePeriod + 30 days]
      where ImagingPeriod starts during HospitalizationPeriod
        and ImagingPeriod starts during ImagingWindow
        and IntravenousHeparinTime starts during HospitalizationPeriod
        and IntravenousHeparinTime starts 24 hours or less after end of ImagingPeriod
        and ( Count("aPTTHeparinMonitoringTests"(SurgicalHeparinEncounter, IntravenousHeparin)) > 1 )
      return IntravenousHeparin
    )

Intracranial Or Spinal Surgery Encounters With PostOp Imaging Study And IVC Filter Placement

  from
    "Intracranial Or Spinal Surgery Encounters With PostOp Imaging Study Between 5 And 30 Days After Surgery" BrainSpinalEncounter,
    "Imaging Study For VTE" ImagingStudy,
    ["Procedure, Performed": "Inferior Vena Cava (IVC) Filter Placement"] IVCFilterPlacement
     let HospitalizationPeriod: Global."HospitalizationWithObservationAndOutpatientSurgeryService"(BrainSpinalEncounter),
        FirstProcedurePeriod: Global."NormalizeInterval" ( "FirstProcedure"(BrainSpinalEncounter).relevantDatetime, "FirstProcedure"(BrainSpinalEncounter).relevantPeriod ),
        IVCFilterPlacementTime: Global."NormalizeInterval" ( IVCFilterPlacement.relevantDatetime, IVCFilterPlacement.relevantPeriod ),
        ImagingPeriod: Global."NormalizeInterval" ( ImagingStudy.relevantDatetime, ImagingStudy.relevantPeriod ),
        ImagingWindow: Interval[end of FirstProcedurePeriod + 5 days, end of FirstProcedurePeriod + 30 days]
     where ImagingPeriod starts during HospitalizationPeriod
        and ImagingPeriod starts during ImagingWindow
        and IVCFilterPlacementTime starts during HospitalizationPeriod
        and IVCFilterPlacementTime starts 24 hours or less after end of ImagingPeriod
    return BrainSpinalEncounter

Intracranial Or Spinal Surgery Encounters With PostOp Imaging Study And Non Heparin Therapeutic Anticoagulant

  from
    "Intracranial Or Spinal Surgery Encounters With PostOp Imaging Study Between 5 And 30 Days After Surgery" BrainSpinalEncounter,
    "Imaging Study For VTE" ImagingStudy,
    "Non Heparin Therapeutic Medication Order" Anticoagulant
    let
    HospitalizationPeriod: Global."HospitalizationWithObservationAndOutpatientSurgeryService"(BrainSpinalEncounter),
    FirstProcedurePeriod: Global."NormalizeInterval"("FirstProcedure"(BrainSpinalEncounter).relevantDatetime,"FirstProcedure"(BrainSpinalEncounter).relevantPeriod),
    ImagingPeriod: Global."NormalizeInterval"(ImagingStudy.relevantDatetime, ImagingStudy.relevantPeriod),
    ImagingWindow: Interval[end of FirstProcedurePeriod + 5 days, end of FirstProcedurePeriod + 30 days]
  where ImagingPeriod starts during HospitalizationPeriod
    and ImagingPeriod starts during ImagingWindow
    and Anticoagulant.authorDatetime during HospitalizationPeriod
    and Anticoagulant.authorDatetime 24 hours or less after end of ImagingPeriod
  return BrainSpinalEncounter

Intracranial Or Spinal Surgery Encounters With PostOp Imaging Study And VTE Diagnosis Not Present On Admission

  "Intracranial Or Spinal Surgery Encounters With PostOp Imaging Study Between 5 And 30 Days After Surgery" BrainSpinalEncounter
    where exists ( BrainSpinalEncounter.diagnoses VTEDiagnosis
        where VTEDiagnosis.code in "Venous Thromboembolism"
          and (VTEDiagnosis.presentOnAdmissionIndicator in "Not Present On Admission or Documentation Insufficient to Determine" or VTEDiagnosis.presentOnAdmissionIndicator is null)
    )

Intracranial Or Spinal Surgery Encounters With PostOp Imaging Study Between 5 And 30 Days After Surgery

  from
    "Encounters With Procedure With Anesthesia In The Operating Room" InpatientEncounter,
    "Intracranial Or Spinal Surgery" BrainSpineSurgery,
    "Imaging Study For VTE" ImagingStudy
    let HospitalizationPeriod: Global."HospitalizationWithObservationAndOutpatientSurgeryService"(InpatientEncounter),
        BrainSpineSurgeryPeriod: Global."NormalizeInterval" ( BrainSpineSurgery.relevantDatetime, BrainSpineSurgery.relevantPeriod ),
        ImagingPeriod: Global."NormalizeInterval" ( ImagingStudy.relevantDatetime, ImagingStudy.relevantPeriod ),
        FirstProcedurePeriod: Global."NormalizeInterval"("FirstProcedure"(InpatientEncounter).relevantDatetime,"FirstProcedure"(InpatientEncounter).relevantPeriod),
        ImagingWindow: Interval[end of FirstProcedurePeriod + 5 days, end of FirstProcedurePeriod + 30 days]
    where BrainSpineSurgeryPeriod during HospitalizationPeriod
      and BrainSpineSurgeryPeriod overlaps FirstProcedurePeriod
      and ImagingPeriod during HospitalizationPeriod
      and ImagingPeriod during ImagingWindow
    return InpatientEncounter

Intracranial Or Spinal Surgery Encounters With PostOp Imaging Study With Evidence Of VTE

  "Intracranial Or Spinal Surgery Encounters With PostOp Imaging Study And Non Heparin Therapeutic Anticoagulant"
    union "Intracranial Or Spinal Surgery Encounters With PostOp Imaging Study And Intravenous Heparin With At Least 2 AntiFactorXa Tests"
    union "Intracranial Or Spinal Surgery Encounters With PostOp Imaging Study And Intravenous Heparin With At Least 2 aPTT Tests"
    union "Intracranial Or Spinal Surgery Encounters With PostOp Imaging Study And IVC Filter Placement"
    union "Intracranial Or Spinal Surgery Encounters With PostOp Imaging Study And VTE Diagnosis Not Present On Admission"

Intravenous Heparin Administration

  ["Medication, Administered": "Heparin"] HeparinMed
    where HeparinMed.route in "Intravenous Heparin Administration Route"

Non Heparin Therapeutic Medication Order

  "Apixiban Greater Than Or Equal To 10mg Daily"
    union "Dalteparin Greater Than Or Equal To 10,000 IU Daily"
    union "Enoxaparin Greater Than 80mg Daily"
    union "Rivaroxaban Greater Than Or Equal To 20 mg Daily"
    union "Fondaparinux Greater Than Or Equal To 5mg Daily"

Numerator

  "Encounters With PostOp Imaging Study Without Intracranial Or Spinal Surgery With Evidence Of VTE"
    union "Intracranial Or Spinal Surgery Encounters With PostOp Imaging Study With Evidence Of VTE"
    union "Encounters With Subsequent VTE Encounter Within 30 Days PostOp"

Risk Variable Age 18-29

    exists ("Initial Population" EncounterIP
    where AgeInYearsAt(date from start of EncounterIP.relevantPeriod) >= 18 and 
    AgeInYearsAt(date from start of EncounterIP.relevantPeriod) <= 29)

Risk Variable Age 30-39

    exists("Initial Population" EncounterIP
    where AgeInYearsAt(date from start of EncounterIP.relevantPeriod) >= 30 and 
    AgeInYearsAt(date from start of EncounterIP.relevantPeriod) <= 39)

Risk Variable Age 40-49

    exists("Initial Population" EncounterIP
    where AgeInYearsAt(date from start of EncounterIP.relevantPeriod) >= 40 and 
    AgeInYearsAt(date from start of EncounterIP.relevantPeriod) <= 49)

Risk Variable Age 50-59

    exists("Initial Population" EncounterIP
    where AgeInYearsAt(date from start of EncounterIP.relevantPeriod) >= 50 and 
    AgeInYearsAt(date from start of EncounterIP.relevantPeriod) <= 59)

Risk Variable Age 60-69

    exists("Initial Population" EncounterIP
    where AgeInYearsAt(date from start of EncounterIP.relevantPeriod) >= 60 and 
    AgeInYearsAt(date from start of EncounterIP.relevantPeriod) <= 69)

Risk Variable Age 70-79

    exists("Initial Population" EncounterIP
    where AgeInYearsAt(date from start of EncounterIP.relevantPeriod) >= 70 and 
    AgeInYearsAt(date from start of EncounterIP.relevantPeriod) <= 79)

Risk Variable Age 80+

    exists("Initial Population" EncounterIP
    where AgeInYearsAt(date from start of EncounterIP.relevantPeriod) >= 80)

Risk Variable Bleeding Disorder

    flatten("Initial Population" EncounterIP
    return(
        EncounterIP.diagnoses Diagnosis
        where Diagnosis.code in "Bleeding Disorder"
    return Tuple {
        encounterId: EncounterIP.id,
        code: Diagnosis.code,
        poa: Diagnosis.presentOnAdmissionIndicator
      }
    ))

Risk Variable Cancer

   flatten( "Initial Population" EncounterIP
    return(
        EncounterIP.diagnoses Diagnosis
        where Diagnosis.code in "Cancer"
    return Tuple {
        encounterId: EncounterIP.id,
        code: Diagnosis.code,
        poa: Diagnosis.presentOnAdmissionIndicator
     }
   ))

Risk Variable Central Venous Catheter Insertion

    ["Procedure, Performed": "CVC Insertion Procedure"] CatheterInsertion
        with "Initial Population" EncounterIP
        such that Global."NormalizeInterval" ( CatheterInsertion.relevantDatetime, CatheterInsertion.relevantPeriod ) during EncounterIP.relevantPeriod
    return Tuple {
        procedureCode: CatheterInsertion.code
    }

Risk Variable Diabetes

   flatten( "Initial Population" EncounterIP
    return(
        EncounterIP.diagnoses Diagnosis
        where Diagnosis.code in "Diabetes"
    return Tuple {
        encounterId: EncounterIP.id,
        code: Diagnosis.code,
        poa: Diagnosis.presentOnAdmissionIndicator
     }
   ))

Risk Variable Female

    exists("Initial Population" EncounterIP 
    with "SDE Sex" Sex
    such that Sex.code ~ "Female (finding)")

Risk Variable Fractures

   flatten( "Initial Population" EncounterIP
    return(
        EncounterIP.diagnoses Diagnosis
        where Diagnosis.code in "Fractures"
    return Tuple {
        encounterId: EncounterIP.id,
        code: Diagnosis.code,
        poa: Diagnosis.presentOnAdmissionIndicator
     }
   ))

Risk Variable Hip Knee Replacement

    (["Procedure, Performed": "Hip Replacement Surgery"] union ["Procedure, Performed": "Knee Replacement Surgery"]) ReplacementSurgery
        with "Initial Population" EncounterIP
        such that Global."NormalizeInterval" ( ReplacementSurgery.relevantDatetime, ReplacementSurgery.relevantPeriod ) during EncounterIP.relevantPeriod
    return Tuple {
        procedureCode: ReplacementSurgery.code
    }

Risk Variable History Of VTE

    "Has High Risk Indicator For VTE" or "Has History Of VTE"

Risk Variable Hormone Therapy

    ["Medication, Active": "Hormone Therapy"] HormoneTherapy
        with "Initial Population" EncounterIP
        such that (Global."NormalizeInterval" ( HormoneTherapy.relevantDatetime, HormoneTherapy.relevantPeriod ) starts before EncounterIP.relevantPeriod
            or Global."NormalizeInterval" ( HormoneTherapy.relevantDatetime, HormoneTherapy.relevantPeriod ) starts during EncounterIP.relevantPeriod)
    return Tuple {
        medicationCode: HormoneTherapy.code
    }

Risk Variable Immobility

   flatten( "Initial Population" EncounterIP
    return(
        EncounterIP.diagnoses Diagnosis
        where Diagnosis.code in "Functional and Mobility Impairment"
    return Tuple {
        encounterId: EncounterIP.id,
        code: Diagnosis.code,
        poa: Diagnosis.presentOnAdmissionIndicator
     }
   ))

Risk Variable Male

    exists("Initial Population" EncounterIP 
    with "SDE Sex" Sex
    such that Sex.code ~ "Male (finding)")

Risk Variable Obesity

   flatten( "Initial Population" EncounterIP
    return(
        EncounterIP.diagnoses Diagnosis
        where Diagnosis.code in "Obesity"
    return Tuple {
        encounterId: EncounterIP.id,
        code: Diagnosis.code,
        poa: Diagnosis.presentOnAdmissionIndicator
     }
   ))

Risk Variable Respiratory Operations

    ["Procedure, Performed": "Respiratory Procedures"] RespiratoryProcedure
        with "Initial Population" EncounterIP
        such that Global."NormalizeInterval" ( RespiratoryProcedure.relevantDatetime, RespiratoryProcedure.relevantPeriod ) during EncounterIP.relevantPeriod
    return Tuple {
        procedureCode: RespiratoryProcedure.code
    }

Risk Variable Stroke

   flatten( "Initial Population" EncounterIP
    return(
        EncounterIP.diagnoses Diagnosis
        where Diagnosis.code in "Stroke"
    return Tuple {
        encounterId: EncounterIP.id,
        code: Diagnosis.code,
        poa: Diagnosis.presentOnAdmissionIndicator
     }
   ))

Risk Variable Tobacco Use

   flatten( "Initial Population" EncounterIP
    return(
        EncounterIP.diagnoses Diagnosis
        where Diagnosis.code in "Smoking status"
    return Tuple {
        encounterId: EncounterIP.id,
        code: Diagnosis.code,
        poa: Diagnosis.presentOnAdmissionIndicator
     }
   ))

Risk Variable Vascular Surgery

    ["Procedure, Performed": "Vascular Surgeries ICD10PCS"] VascularSurgery
        with "Initial Population" EncounterIP
        such that Global."NormalizeInterval" ( VascularSurgery.relevantDatetime, VascularSurgery.relevantPeriod ) during EncounterIP.relevantPeriod
    return Tuple {
        procedureCode: VascularSurgery.code
    }

Rivaroxaban Greater Than Or Equal To 20 mg Daily

  ["Medication, Order": "Rivaroxaban Anticoagulant"] Rivaroxaban
    where Rivaroxaban.dosage >= 20 'mg'
      and Rivaroxaban.frequency ~ "Once daily (qualifier value)"
      or ( Rivaroxaban.dosage >= 10 'mg'
          and Rivaroxaban.frequency ~ "Twice a day (qualifier value)"
      )

SDE Ethnicity

  ["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

  ["Patient Characteristic Payer": "Payer Type"]

SDE Race

  ["Patient Characteristic Race": "Race"]

SDE Sex

  ["Patient Characteristic Sex": "Federal Administrative Sex"]

Subsequent Encounters With VTE Diagnosis

  "Base Qualifying Encounters" Encounter
    let HospitalizationPeriod:
      Global."HospitalizationWithObservationAndOutpatientSurgeryService"(Encounter)
    where exists (Encounter.diagnoses EncounterDiagnoses
        where EncounterDiagnoses.code in "Venous Thromboembolism"
    )

Subsequent Encounters With VTE Diagnosis And VTE Medication

  "Subsequent Encounters With VTE Diagnosis"
    intersect "Subsequent Encounters With VTE Medication"

Subsequent Encounters With VTE Medication

  "Base Qualifying Encounters" Encounter
    let HospitalizationPeriod:
      Global."HospitalizationWithObservationAndOutpatientSurgeryService"(Encounter)
    with "VTE Medication Ordered Or Prescribed" VTEMeds
      such that VTEMeds.authorDatetime during HospitalizationPeriod

Subsequent Encounters With VTE Within 30 Days PostOp

 from
  "Subsequent Encounters With VTE Diagnosis And VTE Medication" SubsequentVTE,
  "Encounters With Procedure With Anesthesia In The Operating Room" IndexEncounter
    let HospitalizationPeriod: Global."HospitalizationWithObservationAndOutpatientSurgeryService"(IndexEncounter)
    where SubsequentVTE.relevantPeriod starts after end of HospitalizationPeriod
        and SubsequentVTE.relevantPeriod starts 30 days or less after
          end of Global."NormalizeInterval"("FirstProcedure"(IndexEncounter).relevantDatetime,"FirstProcedure"(IndexEncounter).relevantPeriod
          )
    return SubsequentVTE

VTE Medication Ordered

  ["Medication, Order": "Non Heparin Anticoagulants for VTE Treatment"]
    union ["Medication, Order": "Heparin for VTE Treatment"]

VTE Medication Ordered Or Prescribed

 "VTE Medication Ordered" union "VTE Medication Prescribed"

VTE Medication Prescribed

    ["Medication, Discharge": "Non Heparin Anticoagulants for VTE Treatment"]
        union ["Medication, Discharge": "Heparin for VTE Treatment"]

AntiFactorXaAssayHeparinMonitoringTests(QualifyingEncounter "Encounter, Performed", IntravenousHeparin "Medication, Administered")

    ["Laboratory Test, Performed": "Anti Factor Xa Assay"] AntiFXaHepMonitoringTest
    let HospitalizationInterval: Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter),
        HeparinMedicationPeriod: Global."NormalizeInterval" ( IntravenousHeparin.relevantDatetime, IntravenousHeparin.relevantPeriod ),
        AntiFXaPeriod: Global."NormalizeInterval" ( AntiFXaHepMonitoringTest.relevantDatetime, AntiFXaHepMonitoringTest.relevantPeriod )
    where AntiFXaPeriod 35 hours or less after start of HeparinMedicationPeriod
      and AntiFXaPeriod during HospitalizationInterval
      and HeparinMedicationPeriod during HospitalizationInterval
    return distinct AntiFXaHepMonitoringTest

FirstProcedure(Encounter "Encounter, Performed")

  First(["Procedure, Performed": "General and Neuraxial Anesthesia"] FirstProc
      where Global."NormalizeInterval"(FirstProc.relevantDatetime, FirstProc.relevantPeriod) starts during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(Encounter)
      and exists (
      Encounter.facilityLocations EncounterLocation
      where EncounterLocation.code ~ "Operating Room/Suite"
      and Global."NormalizeInterval"(FirstProc.relevantDatetime,FirstProc.relevantPeriod)
    starts during EncounterLocation.locationPeriod
      )
      sort by start of Global."NormalizeInterval"(relevantDatetime, relevantPeriod)
  )

Global.Earliest(period Interval<DateTime>)

  if ( HasStart(period)) then start of period 
    else 
  end of period

Global.EarliestOf(pointInTime DateTime, period Interval<DateTime>)
- - Earliest(NormalizeInterval(pointInTime, period))

Global.HasStart(period Interval<DateTime>)

  not ( start of period is null
      or start of period = minimum DateTime
  )

Global.HospitalizationWithObservationAndOutpatientSurgeryService(Encounter "Encounter, Performed")

  Encounter Visit
  	let ObsVisit: Last(["Encounter, Performed": "Observation Services"] LastObs
  			where LastObs.relevantPeriod ends 1 hour or less on or before start of Visit.relevantPeriod
  			sort by 
  			end of relevantPeriod
  	),
  	VisitStart: Coalesce(start of ObsVisit.relevantPeriod, start of Visit.relevantPeriod),
  	EDVisit: Last(["Encounter, Performed": "Emergency Department Visit"] LastED
  			where LastED.relevantPeriod ends 1 hour or less on or before VisitStart
  			sort by 
  			end of relevantPeriod
  	),
  	VisitStartWithED: Coalesce(start of EDVisit.relevantPeriod, VisitStart),
  	OutpatientSurgeryVisit: Last(["Encounter, Performed": "Outpatient Surgery Service"] LastSurgeryOP
  			where LastSurgeryOP.relevantPeriod ends 1 hour or less on or before VisitStartWithED
  			sort by 
  			end of relevantPeriod
  	)
  	return Interval[Coalesce(start of OutpatientSurgeryVisit.relevantPeriod, VisitStartWithED), 
  	end of Visit.relevantPeriod]

Global.LengthInDays(Value Interval<DateTime>)

  difference in days between start of Value and end of Value

Global.NormalizeInterval(pointInTime DateTime, period Interval<DateTime>)

  if pointInTime is not null then Interval[pointInTime, pointInTime]
    else if period is not null then period 
    else null as Interval<DateTime>

aPTTHeparinMonitoringTests(QualifyingEncounter "Encounter, Performed", IntravenousHeparin "Medication, Administered")

    ["Laboratory Test, Performed": "aPTT Tests"] aPTTHepMonitoringTest
    let 
        HospitalizationInterval: Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter),
        HeparinMedicationPeriod: Global."NormalizeInterval" ( IntravenousHeparin.relevantDatetime, IntravenousHeparin.relevantPeriod ),
        aPTTPeriod: Global."NormalizeInterval" ( aPTTHepMonitoringTest.relevantDatetime, aPTTHepMonitoringTest.relevantPeriod )
    where aPTTPeriod 35 hours or less after start of HeparinMedicationPeriod
      and aPTTPeriod during HospitalizationInterval
      and HeparinMedicationPeriod during HospitalizationInterval
    return distinct aPTTHepMonitoringTest

code "Female (finding)" ("SNOMEDCT Code (248152002)")
code "High" ("LOINC Code (LA9193-9)")
code "Male (finding)" ("SNOMEDCT Code (248153007)")
code "Once daily (qualifier value)" ("SNOMEDCT Code (229797004)")
code "Operating Room/Suite" ("HSLOC Code (1096-7)")
code "Personal history of other venous thrombosis and embolism" ("ICD10CM Code (Z86.718)")
code "Risk for venous thromboembolism" ("LOINC Code (72136-5)")
code "Twice a day (qualifier value)" ("SNOMEDCT Code (229799001)")
valueset "Abdominal or Pelvic CT Scan with Contrast" (2.16.840.1.113762.1.4.1147.160)
valueset "Acute Brain or Spinal Injury or Hemorrhage" (2.16.840.1.113762.1.4.1248.79)
valueset "Anti Factor Xa Assay" (2.16.840.1.113762.1.4.1147.183)
valueset "Apixaban" (2.16.840.1.113883.3.1240.15.2.4005)
valueset "aPTT Tests" (2.16.840.1.113762.1.4.1248.109)
valueset "Bleeding Disorder" (2.16.840.1.113762.1.4.1029.286)
valueset "Cancer" (2.16.840.1.113762.1.4.1272.44)
valueset "CT Angiography of Chest" (2.16.840.1.113762.1.4.1147.155)
valueset "CVC Insertion Procedure" (2.16.840.1.113762.1.4.1272.27)
valueset "Dalteparin Anticoagulant" (2.16.840.1.113762.1.4.1248.263)
valueset "Diabetes" (2.16.840.1.113762.1.4.1272.3)
valueset "Emergency Department Visit" (2.16.840.1.113883.3.117.1.7.1.292)
valueset "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
valueset "Enoxaparin Anticoagulant" (2.16.840.1.113762.1.4.1248.268)
valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
valueset "Extracorporeal Membrane Oxygenation" (2.16.840.1.113762.1.4.1248.81)
valueset "Federal Administrative Sex" (2.16.840.1.113762.1.4.1021.121)
valueset "Fondaparinux Anticoagulant" (2.16.840.1.113762.1.4.1248.262)
valueset "Fractures" (2.16.840.1.113762.1.4.1272.10)
valueset "Functional and Mobility Impairment" (2.16.840.1.113762.1.4.1272.6)
valueset "General and Neuraxial Anesthesia" (2.16.840.1.113762.1.4.1248.208)
valueset "Heparin" (2.16.840.1.113762.1.4.1248.264)
valueset "Heparin for VTE Treatment" (2.16.840.1.113762.1.4.1272.29)
valueset "Hip Replacement Surgery" (2.16.840.1.113883.3.117.1.7.1.259)
valueset "Hormone Therapy" (2.16.840.1.113762.1.4.1272.9)
valueset "Inferior Vena Cava (IVC) Filter Placement" (2.16.840.1.113762.1.4.1147.151)
valueset "Intracranial Neurosurgery" (2.16.840.1.113883.3.117.1.7.1.260)
valueset "Intravenous Heparin Administration Route" (2.16.840.1.113762.1.4.1272.26)
valueset "Knee Replacement Surgery" (2.16.840.1.113883.3.117.1.7.1.261)
valueset "Non Heparin Anticoagulants for VTE Treatment" (2.16.840.1.113762.1.4.1272.30)
valueset "Not Present On Admission or Documentation Insufficient to Determine" (2.16.840.1.113762.1.4.1147.198)
valueset "Obesity" (2.16.840.1.113762.1.4.1272.8)
valueset "Observation Services" (2.16.840.1.113762.1.4.1111.143)
valueset "Obstetrics and VTE Obstetrics" (2.16.840.1.113762.1.4.1248.33)
valueset "Outpatient Surgery Service" (2.16.840.1.113762.1.4.1110.38)
valueset "Payer Type" (2.16.840.1.114222.4.11.3591)
valueset "Present on Admission or Clinically Undetermined" (2.16.840.1.113762.1.4.1147.197)
valueset "Pulmonary Arterial Thrombectomy" (2.16.840.1.113762.1.4.1248.80)
valueset "Pulmonary Ventilation/Perfusion (VQ) Scan" (2.16.840.1.113762.1.4.1147.170)
valueset "Race" (2.16.840.1.114222.4.11.836)
valueset "Respiratory Procedures" (2.16.840.1.113762.1.4.1272.15)
valueset "Rivaroxaban Anticoagulant" (2.16.840.1.113762.1.4.1248.260)
valueset "Smoking status" (2.16.840.1.113762.1.4.1272.7)
valueset "Spinal Surgery" (2.16.840.1.113762.1.4.1248.185)
valueset "Stroke" (2.16.840.1.113762.1.4.1248.176)
valueset "Ultrasound of Lower Extremities" (2.16.840.1.113762.1.4.1272.45)
valueset "Vascular Surgeries ICD10PCS" (2.16.840.1.113762.1.4.1272.28)
valueset "Venous Thromboembolism" (2.16.840.1.113883.3.117.1.7.1.279)

"Assessment, Performed: Risk for venous thromboembolism" using "Risk for venous thromboembolism (LOINC Code 72136-5)"
"Diagnostic Study, Performed: Abdominal or Pelvic CT Scan with Contrast" using "Abdominal or Pelvic CT Scan with Contrast (2.16.840.1.113762.1.4.1147.160)"
"Diagnostic Study, Performed: CT Angiography of Chest" using "CT Angiography of Chest (2.16.840.1.113762.1.4.1147.155)"
"Diagnostic Study, Performed: Pulmonary Ventilation/Perfusion (VQ) Scan" using "Pulmonary Ventilation/Perfusion (VQ) Scan (2.16.840.1.113762.1.4.1147.170)"
"Diagnostic Study, Performed: Ultrasound of Lower Extremities" using "Ultrasound of Lower Extremities (2.16.840.1.113762.1.4.1272.45)"
"Encounter, Performed: Emergency Department Visit" using "Emergency Department Visit (2.16.840.1.113883.3.117.1.7.1.292)"
"Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)"
"Encounter, Performed: Observation Services" using "Observation Services (2.16.840.1.113762.1.4.1111.143)"
"Encounter, Performed: Outpatient Surgery Service" using "Outpatient Surgery Service (2.16.840.1.113762.1.4.1110.38)"
"Laboratory Test, Performed: Anti Factor Xa Assay" using "Anti Factor Xa Assay (2.16.840.1.113762.1.4.1147.183)"
"Laboratory Test, Performed: aPTT Tests" using "aPTT Tests (2.16.840.1.113762.1.4.1248.109)"
"Medication, Active: Hormone Therapy" using "Hormone Therapy (2.16.840.1.113762.1.4.1272.9)"
"Medication, Administered: Heparin" using "Heparin (2.16.840.1.113762.1.4.1248.264)"
"Medication, Discharge: Heparin for VTE Treatment" using "Heparin for VTE Treatment (2.16.840.1.113762.1.4.1272.29)"
"Medication, Discharge: Non Heparin Anticoagulants for VTE Treatment" using "Non Heparin Anticoagulants for VTE Treatment (2.16.840.1.113762.1.4.1272.30)"
"Medication, Order: Apixaban" using "Apixaban (2.16.840.1.113883.3.1240.15.2.4005)"
"Medication, Order: Dalteparin Anticoagulant" using "Dalteparin Anticoagulant (2.16.840.1.113762.1.4.1248.263)"
"Medication, Order: Enoxaparin Anticoagulant" using "Enoxaparin Anticoagulant (2.16.840.1.113762.1.4.1248.268)"
"Medication, Order: Fondaparinux Anticoagulant" using "Fondaparinux Anticoagulant (2.16.840.1.113762.1.4.1248.262)"
"Medication, Order: Heparin for VTE Treatment" using "Heparin for VTE Treatment (2.16.840.1.113762.1.4.1272.29)"
"Medication, Order: Non Heparin Anticoagulants for VTE Treatment" using "Non Heparin Anticoagulants for VTE Treatment (2.16.840.1.113762.1.4.1272.30)"
"Medication, Order: Rivaroxaban Anticoagulant" using "Rivaroxaban Anticoagulant (2.16.840.1.113762.1.4.1248.260)"
"Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity (2.16.840.1.114222.4.11.837)"
"Patient Characteristic Payer: Payer Type" using "Payer Type (2.16.840.1.114222.4.11.3591)"
"Patient Characteristic Race: Race" using "Race (2.16.840.1.114222.4.11.836)"
"Patient Characteristic Sex: Federal Administrative Sex" using "Federal Administrative Sex (2.16.840.1.113762.1.4.1021.121)"
"Procedure, Performed: CVC Insertion Procedure" using "CVC Insertion Procedure (2.16.840.1.113762.1.4.1272.27)"
"Procedure, Performed: Extracorporeal Membrane Oxygenation" using "Extracorporeal Membrane Oxygenation (2.16.840.1.113762.1.4.1248.81)"
"Procedure, Performed: General and Neuraxial Anesthesia" using "General and Neuraxial Anesthesia (2.16.840.1.113762.1.4.1248.208)"
"Procedure, Performed: Hip Replacement Surgery" using "Hip Replacement Surgery (2.16.840.1.113883.3.117.1.7.1.259)"
"Procedure, Performed: Inferior Vena Cava (IVC) Filter Placement" using "Inferior Vena Cava (IVC) Filter Placement (2.16.840.1.113762.1.4.1147.151)"
"Procedure, Performed: Intracranial Neurosurgery" using "Intracranial Neurosurgery (2.16.840.1.113883.3.117.1.7.1.260)"
"Procedure, Performed: Knee Replacement Surgery" using "Knee Replacement Surgery (2.16.840.1.113883.3.117.1.7.1.261)"
"Procedure, Performed: Pulmonary Arterial Thrombectomy" using "Pulmonary Arterial Thrombectomy (2.16.840.1.113762.1.4.1248.80)"
"Procedure, Performed: Respiratory Procedures" using "Respiratory Procedures (2.16.840.1.113762.1.4.1272.15)"
"Procedure, Performed: Spinal Surgery" using "Spinal Surgery (2.16.840.1.113762.1.4.1248.185)"
"Procedure, Performed: Vascular Surgeries ICD10PCS" using "Vascular Surgeries ICD10PCS (2.16.840.1.113762.1.4.1272.28)"

  ["Patient Characteristic Ethnicity": "Ethnicity"]

  ["Patient Characteristic Payer": "Payer Type"]

  ["Patient Characteristic Race": "Race"]

  ["Patient Characteristic Sex": "Federal Administrative Sex"]

exists ("Initial Population" EncounterIP
    where AgeInYearsAt(date from start of EncounterIP.relevantPeriod) >= 18 and 
    AgeInYearsAt(date from start of EncounterIP.relevantPeriod) <= 29)

exists("Initial Population" EncounterIP
    where AgeInYearsAt(date from start of EncounterIP.relevantPeriod) >= 30 and 
    AgeInYearsAt(date from start of EncounterIP.relevantPeriod) <= 39)

exists("Initial Population" EncounterIP
    where AgeInYearsAt(date from start of EncounterIP.relevantPeriod) >= 40 and 
    AgeInYearsAt(date from start of EncounterIP.relevantPeriod) <= 49)

exists("Initial Population" EncounterIP
    where AgeInYearsAt(date from start of EncounterIP.relevantPeriod) >= 50 and 
    AgeInYearsAt(date from start of EncounterIP.relevantPeriod) <= 59)

exists("Initial Population" EncounterIP
    where AgeInYearsAt(date from start of EncounterIP.relevantPeriod) >= 60 and 
    AgeInYearsAt(date from start of EncounterIP.relevantPeriod) <= 69)

exists("Initial Population" EncounterIP
    where AgeInYearsAt(date from start of EncounterIP.relevantPeriod) >= 70 and 
    AgeInYearsAt(date from start of EncounterIP.relevantPeriod) <= 79)

exists("Initial Population" EncounterIP
    where AgeInYearsAt(date from start of EncounterIP.relevantPeriod) >= 80)

exists("Initial Population" EncounterIP 
    with "SDE Sex" Sex
    such that Sex.code ~ "Male (finding)")

exists("Initial Population" EncounterIP 
    with "SDE Sex" Sex
    such that Sex.code ~ "Female (finding)")

flatten("Initial Population" EncounterIP
    return(
        EncounterIP.diagnoses Diagnosis
        where Diagnosis.code in "Bleeding Disorder"
    return Tuple {
        encounterId: EncounterIP.id,
        code: Diagnosis.code,
        poa: Diagnosis.presentOnAdmissionIndicator
      }
    ))

flatten( "Initial Population" EncounterIP
    return(
        EncounterIP.diagnoses Diagnosis
        where Diagnosis.code in "Cancer"
    return Tuple {
        encounterId: EncounterIP.id,
        code: Diagnosis.code,
        poa: Diagnosis.presentOnAdmissionIndicator
     }
   ))

["Procedure, Performed": "CVC Insertion Procedure"] CatheterInsertion
        with "Initial Population" EncounterIP
        such that Global."NormalizeInterval" ( CatheterInsertion.relevantDatetime, CatheterInsertion.relevantPeriod ) during EncounterIP.relevantPeriod
    return Tuple {
        procedureCode: CatheterInsertion.code
    }

flatten( "Initial Population" EncounterIP
    return(
        EncounterIP.diagnoses Diagnosis
        where Diagnosis.code in "Diabetes"
    return Tuple {
        encounterId: EncounterIP.id,
        code: Diagnosis.code,
        poa: Diagnosis.presentOnAdmissionIndicator
     }
   ))

flatten( "Initial Population" EncounterIP
    return(
        EncounterIP.diagnoses Diagnosis
        where Diagnosis.code in "Fractures"
    return Tuple {
        encounterId: EncounterIP.id,
        code: Diagnosis.code,
        poa: Diagnosis.presentOnAdmissionIndicator
     }
   ))

(["Procedure, Performed": "Hip Replacement Surgery"] union ["Procedure, Performed": "Knee Replacement Surgery"]) ReplacementSurgery
        with "Initial Population" EncounterIP
        such that Global."NormalizeInterval" ( ReplacementSurgery.relevantDatetime, ReplacementSurgery.relevantPeriod ) during EncounterIP.relevantPeriod
    return Tuple {
        procedureCode: ReplacementSurgery.code
    }

"Has High Risk Indicator For VTE" or "Has History Of VTE"

["Medication, Active": "Hormone Therapy"] HormoneTherapy
        with "Initial Population" EncounterIP
        such that (Global."NormalizeInterval" ( HormoneTherapy.relevantDatetime, HormoneTherapy.relevantPeriod ) starts before EncounterIP.relevantPeriod
            or Global."NormalizeInterval" ( HormoneTherapy.relevantDatetime, HormoneTherapy.relevantPeriod ) starts during EncounterIP.relevantPeriod)
    return Tuple {
        medicationCode: HormoneTherapy.code
    }

flatten( "Initial Population" EncounterIP
    return(
        EncounterIP.diagnoses Diagnosis
        where Diagnosis.code in "Functional and Mobility Impairment"
    return Tuple {
        encounterId: EncounterIP.id,
        code: Diagnosis.code,
        poa: Diagnosis.presentOnAdmissionIndicator
     }
   ))

flatten( "Initial Population" EncounterIP
    return(
        EncounterIP.diagnoses Diagnosis
        where Diagnosis.code in "Obesity"
    return Tuple {
        encounterId: EncounterIP.id,
        code: Diagnosis.code,
        poa: Diagnosis.presentOnAdmissionIndicator
     }
   ))

["Procedure, Performed": "Respiratory Procedures"] RespiratoryProcedure
        with "Initial Population" EncounterIP
        such that Global."NormalizeInterval" ( RespiratoryProcedure.relevantDatetime, RespiratoryProcedure.relevantPeriod ) during EncounterIP.relevantPeriod
    return Tuple {
        procedureCode: RespiratoryProcedure.code
    }

flatten( "Initial Population" EncounterIP
    return(
        EncounterIP.diagnoses Diagnosis
        where Diagnosis.code in "Stroke"
    return Tuple {
        encounterId: EncounterIP.id,
        code: Diagnosis.code,
        poa: Diagnosis.presentOnAdmissionIndicator
     }
   ))

flatten( "Initial Population" EncounterIP
    return(
        EncounterIP.diagnoses Diagnosis
        where Diagnosis.code in "Smoking status"
    return Tuple {
        encounterId: EncounterIP.id,
        code: Diagnosis.code,
        poa: Diagnosis.presentOnAdmissionIndicator
     }
   ))

["Procedure, Performed": "Vascular Surgeries ICD10PCS"] VascularSurgery
        with "Initial Population" EncounterIP
        such that Global."NormalizeInterval" ( VascularSurgery.relevantDatetime, VascularSurgery.relevantPeriod ) during EncounterIP.relevantPeriod
    return Tuple {
        procedureCode: VascularSurgery.code
    }

Hospital Harm - Postoperative Venous Thromboembolism

Table of Contents

Population Criteria

Definitions

Functions

Terminology

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables