Hospital Harm - Postoperative Respiratory Failure 1.0.000

This measure assesses the number of elective inpatient hospitalizations for patients aged 18 years and older without an obstetrical condition who have a procedure resulting in postoperative respiratory failure (PRF)

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. American Institutes for Research(R), formerly IMPAQ International, disclaims all liability for use or accuracy of any third party codes contained in the specifications.

LOINC(R) copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 copyright 2023 World Health Organization. All Rights Reserved.

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.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. 

Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

Variables are collected for the development of baseline risk adjustment model

Report the first resulted vital sign values during the encounter in the Unified Code for Units of Measure
(UCUM) units specified:
 - Body temperature: Cel, [degF]
 - Heart rate:  {Beats}/min
 - Respiratory rate: {Breaths}/min
 - Systolic blood pressure:  mm[Hg]

Report the first resulted laboratory test values during the encounter in UCUM units specified:
 - Albumin: g/dL, umol/L
 - Aspartate aminotransferase (AST/SGOT): U/L, IU/L
 - Bicarbonate: mmol/L
 - Bilirubin: mg/dL, umol/L
 - Blood urea nitrogen (BUN): mg/dL, umol/L
 - Carbon dioxide (partial pressure): mm[Hg]
 - Creatinine: mg/dL, umol/L
 - Hematocrit: %
 - Hemoglobin: g/dL, mmol/L
 - Leukocyte count: {cells}/uL, 10*3/uL, 10*9/L,  /mm3
 - Oxygen (partial pressure): mm[Hg]
 - pH of arterial blood: [pH]
 - Platelet count: 10*3/uL, 10*9/L, /mm3
 - Sodium: meq/L, mmol/L
 - White blood cell count: {cells}/uL, 10*3/uL, 10*9/L,  /mm3

Additional variables used for risk adjustment:
 - American Society of Anesthesiologists (ASA) physical status class assessment that starts during the encounter
 - First Body mass index (BMI), reported using UCUM unit: kg/m2
 - Encounter diagnoses with their present on admission (POA) indicators
 - Most recent smoking status
 - Principal surgical procedures that start during the encounter

Please see the Hospital Harm - Postoperative Respiratory Failure Risk Adjustment Methodology Report on the eCQM-specific page on the eCQI Resource Center website: https://ecqi.healthit.gov/

Postoperative respiratory failure (PRF), defined as unplanned endotracheal reintubation, prolonged inability to wean from mechanical ventilation, or inadequate oxygenation and/or ventilation, is the most common serious postoperative pulmonary complication, with an incidence of up to 7.5% (the incidence of any postoperative pulmonary complication ranges from 10-40%) (Arozullah et al., 2000; Canet et al., 2015; Gupta et al., 2011; Kor et al., 2014). This measure addresses the prevalence of PRF and the variance between hospitals in the incidence of PRF. PRF is a serious complication that can increase the risk of morbidity and mortality, with in-hospital mortality resulting from PRF estimated at 25% to 40% (Arozullah et al., 2000; Canet & Gallart, 2014). Surgical procedures complicated by PRF have 3.74 times higher adjusted odds of death than those not complicated by respiratory failure, 1.47 times higher odds of 90-day readmission, and 1.86 times higher odds of an outpatient visit with one of 44 postoperative conditions (e.g., bacterial infection, fluid and electrolyte disorder, abdominal hernia) within 90 days of hospital discharge (Miller et al., 2001; Romano et al, 2009). PRF is additionally associated with prolonged mechanical ventilation and the need for rehabilitation or skilled nursing facility placement upon discharge (Thompson & Lisco, 2018).

The incidence of PRF varies by hospital, with higher reported rates of PRF in nonteaching hospitals than teaching hospitals (Rahman et al., 2013). Additionally, one study found that the odds of developing PRF increased by 6% for each level increase in hospital size from small to large (Rahman et al., 2013). This suggests that there remains room for improvement in hospitals reporting higher rates of PRF.

The most widely used current measures of PRF are based on either claims data (CMS Patient Safety Indicator (PSI) 11) or proprietary registry data (National Surgical Quality Improvement Program (NSQIP) of the American College of Surgeons). The proposed eCQM is closely modeled after the NSQIP measure of PRF, which has been widely adopted across American hospitals, and is intended to complement and eventually supplant CMS PSI 11.

Recent studies and current clinical practice guidelines for PRF have identified enhanced recovery pathways, prophylactic mucolytics, postoperative continuous positive airway pressure ventilation, lung protective intraoperative ventilation, prophylactic respiratory physiotherapy, epidural analgesia, and goal directed hemodynamic therapy as evidence-based interventions to reduce the incidence of PRF. Yet, progress in reducing the incidence of PRF has been stymied by lack of consensus regarding the definition of PRF, which patients are most at-risk, which risk factors are potentially modifiable, and which patients are more likely to benefit from targeted interventions of a health care system’s limited resources. This measure would address this gap in data.

A lower measure score indicates higher quality

Reference Type: CITATION

Reference Text: 'Arozullah, A.M., Daley, J., Henderson, W.G., & Khuri, S.F. (2000). Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The National Veterans Administration Surgical Quality Improvement Program. Annals of surgery. 232(2):242-253. doi: 10.1097/00000658-200008000-00015. PMID: 10903604; PMCID: PMC1421137.'

Reference Type: CITATION

Reference Text: 'Canet, J., & Gallart, L. (2014). Postoperative respiratory failure: Pathogenesis, prediction, and prevention. Current Opinion in Critical Care. 20(1):56-62. doi: 10.1097/MCC.0000000000000045. PMID: 24240985.'

Reference Type: CITATION

Reference Text: 'Canet, J., Sabaté, S., Mazo, V., Gallart, L., de Abreu, M.G., Belda, J., ... & Pelosi, P. (2015). PERISCOPE group. Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort: A prospective, observational study. Eur J Anaesthesiol. 32(7):458-70. doi: 10.1097/EJA.0000000000000223. PMID: 26020123.'

Reference Type: CITATION

Reference Text: 'Gupta, H., Gupta, P.K., Fang, X., Miller, W.J., Cemaj, S., Forse, R.A., & Morrow, L.E. (2011). Development and validation of a risk calculator predicting postoperative respiratory failure. Chest. 140(5):1207-1215. doi: 10.1378/chest.11-0466. Epub 2011 Jul 14. PMID: 21757571.'

Reference Type: CITATION

Reference Text: 'Kor, D.J., Lingineni, R.K., Gajic, O., Park, P.K., Blum, J.M., Hou, P.C., ... & Talmor, D.S. (2014). Predicting risk of postoperative lung injury in high-risk surgical patients: a multicenter cohort study. Anesthesiology. 120(5):1168-81. doi: 10.1097/ALN.0000000000000216. PMID: 24755786; PMCID: PMC3999474.'

Reference Type: CITATION

Reference Text: 'Miller, M.R., Elixhauser, A., Zhan, C., & Meyer, G.S. (2001). Patient Safety Indicators: using administrative data to identify potential patient safety concerns. Health Serv Res. 36(6 Pt 2):110-32. PMID: 16148964; PMCID: PMC1383610.'

Reference Type: CITATION

Reference Text: 'Rahman, M., Neal, D., Fargen, K.M., & Hoh, B.L. (2013). Establishing standard performance measures for adult brain tumor patients: a Nationwide Inpatient Sample database study. Neuro Oncol. 15(11):1580-8. doi: 10.1093/neuonc/not108. Epub 2013 Sep 30. PMID: 24084409; PMCID: PMC3813415.'

Reference Type: CITATION

Reference Text: 'Romano, P.S., Mull, H.J., Rivard, P.E., Zhao, S., Henderson, W.G., Loveland, S., Tsilimingras, D., ... & Rosen, A.K. (2009). Validity of selected AHRQ patient safety indicators based on VA National Surgical Quality Improvement Program data. Health Serv Res. 44(1):182-204. doi: 10.1111/j.1475-6773.2008.00905.x. Epub 2008 Sep 17. PMID: 18823449; PMCID: PMC2669628.'

Reference Type: CITATION

Reference Text: 'Thompson, S.L., & Lisco, S.J. (2018). Postoperative respiratory failure. Int Anesthesiol Clin. 56(1):147-164. doi: 10.1097/AIA.0000000000000173. PMID: 29189437.'

Inpatient hospitalizations: Includes time in outpatient surgery service or observation when the transition between these encounters (if they exist) and the inpatient encounter are within an hour or less of each other.

"Elective Inpatient Encounter" value set intends to capture all scheduled hospitalizations and excludes emergency, urgent, and unplanned admissions.

Elective surgical procedures: Elective is modeled by specifying an elective inpatient admission encounter type with an encounter class of ‘elective’. Surgical procedure is referred to as an "Operating Room (OR) procedure" or "procedure" and is modeled by the use of anesthesia during the encounter. These combined concepts determine a qualifying elective surgical procedure occurred.

The ‘First’ OR procedure of the encounter is captured by an administration of general or neuraxial anesthesia, typically only given and monitored within an operating room environment. These anesthesia concepts are included in the ‘General or Neuraxial Anesthesia’ value set.

All other subsequent procedures are captured by an administration of general, neuraxial, regional anesthesia and conscious sedation that requires monitored anesthesia care (MAC) regardless of procedural area location. These anesthesia concepts are included in the "Anesthesia Requiring Monitored Care" value set.

Procedural area locations include operating rooms, endoscopy, cardiac catheterization and interventional radiology suites. Procedural area locations are also defined by areas where there is an administration of general, neuraxial, regional anesthesia or conscious sedation that requires MAC.

Non-invasive oxygen therapy refers to patients on room air, nasal cannula, face masks, or continuous or intermittent positive airway pressure devices.

PRF is evaluated using mechanical ventilation (MV) documentation or intubation and extubation documentation to allow for hospital documentation variances. Therefore, if MV documentation is not available, intubation and extubation can serve as a proxy for determining if MV occurred and its duration. To determine that an unplanned initiation of MV occurred, the logic looks for evidence of a non-invasive oxygen therapy assessment such as oxygen via 'nasal canula' or 'breathing room air' prior to the MV occurrence to verify that MV was newly initiated. Additionally, facility location codes are used to determine if MV was initiated outside of a procedural area (e.g., medical floor). Conversely, to determine MV duration, the logic looks for evidence that a non-invasive oxygen therapy assessment or another operating room procedure does not exist prior to the MV occurrence to verify that MV was continued without interruption from a procedural area. 
	
This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or 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.

Elective inpatient hospitalizations with no preceding emergency department visit that end during the measurement period for patients aged 18 and older without an obstetrical condition and at least one surgical procedure was performed within the first 3 days of the encounter

Equals Initial Population

Inpatient hospitalizations for patients:

With a diagnosis for a degenerative neurological disorder

With any selected head, neck, and thoracic surgery involving significant risk of airway compromise or requiring airway protection

Who have mechanical ventilation that starts more than one hour prior to the start of the first operating procedure (OR) procedure

With a diagnosis for a neuromuscular disorder

With arterial partial pressure of carbon dioxide (PaCO2)>50 mmHg combined with an arterial pH<7.30 within 48 hours or less prior to the start of the first OR procedure

With arterial partial pressure of oxygen (PaO2)<50 mmHg within 48 hours or less prior to the start of the first OR procedure

With a principal diagnosis for acute respiratory failure

With a secondary diagnosis for acute respiratory failure present on admission

With any diagnosis present on admission for the existence of a tracheostomy

Where a tracheostomy is performed before or on the same day as the first OR procedure

Elective inpatient hospitalizations for patients with postoperative respiratory failure as evidenced by any of the following:

Criterion A: Mechanical ventilation (MV) initiated within 30 days after first OR procedure, as evidenced by:

A.1. Intubation that occurs outside of a procedural area and within 30 days after the end of the first OR procedure of the encounter.

or

A.2. MV that occurs outside of a procedural area within 30 days after the end of the first OR procedure of the encounter and is preceded by a period of non-invasive oxygen therapy between the end of the OR procedure and the MV occurrence, and without a subsequent OR procedure between the non-invasive oxygen therapy and the MV occurrence.

or

Criterion B: MV with a duration of more than 48 hours after the first OR procedure, as evidenced by:

B.1. Extubation that occurs outside of a procedural area more than 48 hours after the end of an OR procedure and within 30 days after the end of the first OR procedure, and is not preceded by a period of non-invasive oxygen therapy or a subsequent OR procedure between the end of the OR procedure and the extubation occurrence.

or

B.2 Mechanical ventilation that occurs between 48 and 72 hours after the end of an OR procedure and within 30 days after the end of the first OR procedure, and is not preceded by a non-invasive oxygen therapy or a subsequent OR procedure between the end of the OR procedure and the MV occurrence.

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

Initial Population

"Elective Inpatient Encounter with OR Procedure within 3 Days"

- Denominator
  - "Initial Population"

Denominator Exclusions

"Encounter with Degenerative Neurological Disorder"
  union "Encounter with High Risk to Airway Head Neck and Thoracic Surgery"
  union "Encounter with Mechanical Ventilation that Starts More than One Hour Prior to Start of First OR Procedure"
  union "Encounter with Neuromuscular Disorder"
  union "Encounter with PaCO2 Greater Than 50 and Arterial pH Less Than 7.30 within 48 Hours Prior to Start of First OR Procedure"
  union "Encounter with PaO2 Less Than 50 within 48 Hours Prior to Start of First OR Procedure"
  union "Encounter with Principal Diagnosis of Acute Respiratory Failure"
  union "Encounter with Secondary Diagnosis of Acute Respiratory Failure Present on Admission"
  union "Encounter with Tracheostomy Present on Admission"
  union "Encounter with Tracheostomy Prior to or on the Same Day of First OR Procedure"

Numerator

"Encounter with Intubation Outside of Procedural Area within 30 Days of End of First OR Procedure"
  union "Encounter with Mechanical Ventilation Outside of Procedural Area within 30 Days of End of First OR Procedure and Preceded by Non Invasive Oxygen Therapy"
  union "Encounter with Extubation Outside of Procedural Area within 30 Days of End of First OR Procedure More Than 48 Hours After End of Anesthesia"
  union "Encounter with Mechanical Ventilation within 30 Days of End of First OR Procedure and Between 48 and 72 Hours After End of OR Procedure and not Preceded by Non Invasive Oxygen Therapy or Anesthesia"

- Numerator Exclusions
  - None

- Denominator Exceptions
  - None

- Stratification
  - None

Anesthesia Procedure List

["Procedure, Performed": "General and Neuraxial Anesthesia"] AnesthesiaProcedures
  where Global."LatestOf" ( AnesthesiaProcedures.relevantDatetime, AnesthesiaProcedures.relevantPeriod ) during day of "Measurement Period"

Denominator
- - "Initial Population"

Denominator Exclusions

"Encounter with Degenerative Neurological Disorder"
  union "Encounter with High Risk to Airway Head Neck and Thoracic Surgery"
  union "Encounter with Mechanical Ventilation that Starts More than One Hour Prior to Start of First OR Procedure"
  union "Encounter with Neuromuscular Disorder"
  union "Encounter with PaCO2 Greater Than 50 and Arterial pH Less Than 7.30 within 48 Hours Prior to Start of First OR Procedure"
  union "Encounter with PaO2 Less Than 50 within 48 Hours Prior to Start of First OR Procedure"
  union "Encounter with Principal Diagnosis of Acute Respiratory Failure"
  union "Encounter with Secondary Diagnosis of Acute Respiratory Failure Present on Admission"
  union "Encounter with Tracheostomy Present on Admission"
  union "Encounter with Tracheostomy Prior to or on the Same Day of First OR Procedure"

Elective Inpatient Encounter with Age 18 and Older without ED Visit

["Encounter, Performed": "Elective Inpatient Encounter"] ElectiveEncounter
  where ElectiveEncounter.relevantPeriod ends during day of "Measurement Period"
    and ElectiveEncounter.class ~ "Elective (qualifier value)"
    and AgeInYearsAt(date from start of ElectiveEncounter.relevantPeriod) >= 18
    and not exists ( ["Encounter, Performed": "Emergency Department Visit"] EDVisit
        where EDVisit.relevantPeriod ends 1 hour or less before or on start of ElectiveEncounter.relevantPeriod
    )

Elective Inpatient Encounter with Age and without Obstetrical Condition

"Elective Inpatient Encounter with Age 18 and Older without ED Visit" ElectiveEncounter
  where not exists ElectiveEncounter.diagnoses EncounterDiagnoses
    where EncounterDiagnoses.code in "Obstetrical or Pregnancy Related Conditions"

Elective Inpatient Encounter with OR Procedure within 3 Days

"Elective Inpatient Encounter with Age and without Obstetrical Condition" ElectiveEncounter
  with ["Procedure, Performed": "General and Neuraxial Anesthesia"] SurgeryWithAnesthesia
    such that Global."EarliestOf" ( SurgeryWithAnesthesia.relevantDatetime, SurgeryWithAnesthesia.relevantPeriod ) during Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( ElectiveEncounter )
      and Global."EarliestOf" ( SurgeryWithAnesthesia.relevantDatetime, SurgeryWithAnesthesia.relevantPeriod ) 3 days or less after start of Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( ElectiveEncounter )

Encounter with Degenerative Neurological Disorder

"Elective Inpatient Encounter with OR Procedure within 3 Days" EncounterWithSurgery
  where exists ( EncounterWithSurgery.diagnoses EncounterDiagnosis
      where EncounterDiagnosis.code in "Degenerative Neurological Disorder"
  )

Encounter with Extubation Outside of Procedural Area within 30 Days of End of First OR Procedure More Than 48 Hours After End of Anesthesia

from
  "Elective Inpatient Encounter with OR Procedure within 3 Days" EncounterWithSurgery,
  ["Procedure, Performed": "Removal of endotracheal tube (procedure)"] Extubation
  let ExtubationTime: Global."NormalizeInterval" ( Extubation.relevantDatetime, Extubation.relevantPeriod ),
  FirstProcedureTime: Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod ),
  GATime: Global."NormalizeInterval" ( "LatestGeneralAnesthesiaOrMAC"(Extubation).relevantDatetime, "LatestGeneralAnesthesiaOrMAC"(Extubation).relevantPeriod ),
  HospitalizationPeriod: Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( EncounterWithSurgery )
  where ExtubationTime during HospitalizationPeriod
    and ExtubationTime starts 30 days or less after end of FirstProcedureTime
    and ExtubationTime starts more than 48 hours after end of GATime
    and not ( ( "Extubation with Preceding Noninvasive Oxygen".id contains Extubation.id )
        and not ( "Extubation During General Anesthesia".id contains Extubation.id )
    )
    and not exists ( EncounterWithSurgery.facilityLocations EncounterLocation
        where EncounterLocation.code in "Procedural Hospital Locations"
    )
  return EncounterWithSurgery

Encounter with High Risk to Airway Head Neck and Thoracic Surgery

"Elective Inpatient Encounter with OR Procedure within 3 Days" EncounterWithSurgery
  with ["Procedure, Performed": "Head, Neck, and Thoracic Surgeries with High Risk Airway Compromise"] HeadNeckProcedures
    such that Global."NormalizeInterval" ( HeadNeckProcedures.relevantDatetime, HeadNeckProcedures.relevantPeriod ) starts during Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( EncounterWithSurgery )

Encounter with Intubation Outside of Procedural Area within 30 Days of End of First OR Procedure

from
  "Elective Inpatient Encounter with OR Procedure within 3 Days" EncounterWithSurgery,
  ["Procedure, Performed": "Intubation"] EndotrachealTubeIn
  let IntubationTime: Global."NormalizeInterval" ( EndotrachealTubeIn.relevantDatetime, EndotrachealTubeIn.relevantPeriod ),
  FirstProcedureTime: Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod ),
  GATime: Global."NormalizeInterval" ( "LatestGeneralAnesthesiaOrMAC"(EndotrachealTubeIn).relevantDatetime, "LatestGeneralAnesthesiaOrMAC"(EndotrachealTubeIn).relevantPeriod ),
  HospitalizationPeriod: Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( EncounterWithSurgery )
  where IntubationTime starts 30 days or less after end of FirstProcedureTime
    and IntubationTime starts during HospitalizationPeriod
    and IntubationTime starts after end of GATime
    and not exists ( EncounterWithSurgery.facilityLocations EncounterLocation
        where EncounterLocation.code in "Procedural Hospital Locations"
          and IntubationTime starts during EncounterLocation.locationPeriod
    )
    and not ( "Intubation During General Anesthesia and MAC".id contains EndotrachealTubeIn.id )
  return EncounterWithSurgery

Encounter with Mechanical Ventilation Outside of Procedural Area within 30 Days of End of First OR Procedure and Preceded by Non Invasive Oxygen Therapy

from
  "Elective Inpatient Encounter with OR Procedure within 3 Days" EncounterWithSurgery,
  ["Procedure, Performed": "Mechanical Ventilation"] Ventilation,
  "Noninvasive Oxygen Therapy" OxygenSupport
  let MVTime: Global."NormalizeInterval" ( Ventilation.relevantDatetime, Ventilation.relevantPeriod ),
  FirstProcedureTime: Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod ),
  GATime: Global."NormalizeInterval" ( "LatestGeneralAnesthesiaOrMAC"(Ventilation).relevantDatetime, "LatestGeneralAnesthesiaOrMAC"(Ventilation).relevantPeriod ),
  HospitalizationPeriod: Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( EncounterWithSurgery ),
  OxygenTime: Global."NormalizeInterval" ( OxygenSupport.relevantDatetime, OxygenSupport.relevantPeriod )
  where MVTime starts 30 days or less after end of FirstProcedureTime
    and MVTime starts during HospitalizationPeriod
    and MVTime starts after end of GATime
    and OxygenTime starts during Interval[end of GATime, start of MVTime]
    and not exists ( EncounterWithSurgery.facilityLocations EncounterLocation
        where EncounterLocation.code in "Procedural Hospital Locations"
          and MVTime starts during EncounterLocation.locationPeriod
    )
  return EncounterWithSurgery

Encounter with Mechanical Ventilation that Starts More than One Hour Prior to Start of First OR Procedure

"Elective Inpatient Encounter with OR Procedure within 3 Days" EncounterWithSurgery
  with ["Procedure, Performed": "Mechanical Ventilation"] Ventilation
    such that Global."NormalizeInterval" ( Ventilation.relevantDatetime, Ventilation.relevantPeriod ) starts more than 1 hour before start of Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod )
      and Global."NormalizeInterval" ( Ventilation.relevantDatetime, Ventilation.relevantPeriod ) starts during Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( EncounterWithSurgery )

Encounter with Mechanical Ventilation within 30 Days of End of First OR Procedure and Between 48 and 72 Hours After End of OR Procedure and not Preceded by Non Invasive Oxygen Therapy or Anesthesia

from
  "Elective Inpatient Encounter with OR Procedure within 3 Days" EncounterWithSurgery,
  ["Procedure, Performed": "Mechanical Ventilation"] Ventilation
  let MVTime: Global."NormalizeInterval" ( Ventilation.relevantDatetime, Ventilation.relevantPeriod ),
  GATime: Global."NormalizeInterval" ( "LatestGeneralAnesthesiaOrMAC"(Ventilation).relevantDatetime, "LatestGeneralAnesthesiaOrMAC"(Ventilation).relevantPeriod ),
  FirstProcedureTime: Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod ),
  HospitalizationPeriod: Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( EncounterWithSurgery )
  where MVTime starts during Interval ( end of GATime + 48 hours, end of GATime + 72 hours )
    and MVTime starts 30 days or less after end of FirstProcedureTime
    and MVTime starts during HospitalizationPeriod
    and not ( "Encounter with Mechanical Ventilation Outside of Procedural Area within 30 Days of End of First OR Procedure and Preceded by Non Invasive Oxygen Therapy".id contains EncounterWithSurgery.id )
    and not exists ( EncounterWithSurgery.facilityLocations EncounterLocation
        where EncounterLocation.code in "Procedural Hospital Locations"
    )
  return EncounterWithSurgery

Encounter with Neuromuscular Disorder

"Elective Inpatient Encounter with OR Procedure within 3 Days" EncounterWithSurgery
  where exists ( EncounterWithSurgery.diagnoses EncounterDiagnosis
      where EncounterDiagnosis.code in "Neuromuscular Disorder"
  )

Encounter with PaCO2 Greater Than 50 and Arterial pH Less Than 7.30 within 48 Hours Prior to Start of First OR Procedure

from
  "Elective Inpatient Encounter with OR Procedure within 3 Days" EncounterWithSurgery,
  ["Laboratory Test, Performed": "Carbon Dioxide Partial Pressure in Arterial Blood"] CarbonDioxide,
  ["Laboratory Test, Performed": "Arterial Blood pH"] BloodpH
  where Global."NormalizeInterval" ( CarbonDioxide.relevantDatetime, CarbonDioxide.relevantPeriod ) starts 48 hours or less before start of Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod )
    and CarbonDioxide.result as Quantity > 50 'mm[Hg]'
    and Global."NormalizeInterval" ( BloodpH.relevantDatetime, BloodpH.relevantPeriod ) starts 48 hours or less before start of Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod )
    and BloodpH.result as Quantity < 7.30 'mm[Hg]'
    and ( Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod ) starts during Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( EncounterWithSurgery ) )
  return EncounterWithSurgery

Encounter with PaO2 Less Than 50 within 48 Hours Prior to Start of First OR Procedure

"Elective Inpatient Encounter with OR Procedure within 3 Days" EncounterWithSurgery
  with ["Laboratory Test, Performed": "Oxygen Partial Pressure in Arterial Blood"] Oxygen
    such that Global."NormalizeInterval" ( Oxygen.relevantDatetime, Oxygen.relevantPeriod ) starts 48 hours or less before start of Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod )
      and Oxygen.result as Quantity < 50 'mm[Hg]'
      and Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod ) starts during Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( EncounterWithSurgery )
  return EncounterWithSurgery

Encounter with Principal Diagnosis of Acute Respiratory Failure

"Elective Inpatient Encounter with OR Procedure within 3 Days" EncounterWithSurgery
  where exists ( EncounterWithSurgery.diagnoses Diagnosis
      where Diagnosis.code in "Acute Respiratory Failure"
        and Diagnosis.rank = 1
  )

Encounter with Secondary Diagnosis of Acute Respiratory Failure Present on Admission

"Elective Inpatient Encounter with OR Procedure within 3 Days" EncounterWithSurgery
  where exists ( EncounterWithSurgery.diagnoses Diagnosis
      where Diagnosis.code in "Acute Respiratory Failure"
        and Diagnosis.rank >= 2
        and Diagnosis.presentOnAdmissionIndicator in "Present on Admission or Clinically Undetermined"
  )

Encounter with Tracheostomy Before Day of First OR Procedure

"Elective Inpatient Encounter with OR Procedure within 3 Days" EncounterWithSurgery
  with ["Procedure, Performed": "Tracheostomy Procedures"] TracheostomySurgery
    such that Global."NormalizeInterval" ( TracheostomySurgery.relevantDatetime, TracheostomySurgery.relevantPeriod ) starts during Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( EncounterWithSurgery )
      and Global."NormalizeInterval" ( TracheostomySurgery.relevantDatetime, TracheostomySurgery.relevantPeriod ) starts before day of Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod )
      and Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod ) starts during Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( EncounterWithSurgery )

Encounter with Tracheostomy Present on Admission

"Elective Inpatient Encounter with OR Procedure within 3 Days" EncounterWithSurgery
  where exists ( EncounterWithSurgery.diagnoses Dx
      where Dx.code in "Tracheostomy Diagnoses"
        and Dx.presentOnAdmissionIndicator in "Present on Admission or Clinically Undetermined"
  )

Encounter with Tracheostomy Prior to or on the Same Day of First OR Procedure

"Encounter with Tracheostomy Before Day of First OR Procedure"
  union "Encounter with Tracheostomy Same Day of First OR Procedure"

Encounter with Tracheostomy Same Day of First OR Procedure

"Elective Inpatient Encounter with OR Procedure within 3 Days" EncounterWithSurgery
  with ["Procedure, Performed": "Tracheostomy Procedures"] TracheostomySurgery
    such that Global."NormalizeInterval" ( TracheostomySurgery.relevantDatetime, TracheostomySurgery.relevantPeriod ) starts during Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( EncounterWithSurgery )
      and Global."NormalizeInterval" ( TracheostomySurgery.relevantDatetime, TracheostomySurgery.relevantPeriod ) starts during day of Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod )
      and Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod ) starts during Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( EncounterWithSurgery )

Extubation During General Anesthesia

from
  "Elective Inpatient Encounter with OR Procedure within 3 Days" EncounterWithSurgery,
  ["Procedure, Performed": "Removal of endotracheal tube (procedure)"] GAExtubation,
  "General Anesthesia and MAC" ProcedureWithAnesthesia
  let GAExtubationTime: Global."NormalizeInterval" ( GAExtubation.relevantDatetime, GAExtubation.relevantPeriod ),
  AnesthesiaTime: Global."NormalizeInterval" ( ProcedureWithAnesthesia.relevantDatetime, ProcedureWithAnesthesia.relevantPeriod ),
  HospitalizationPeriod: Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( EncounterWithSurgery )
  where GAExtubationTime starts during AnesthesiaTime
    and GAExtubationTime starts during HospitalizationPeriod
  return GAExtubation

Extubation with Preceding Noninvasive Oxygen

from
  "Elective Inpatient Encounter with OR Procedure within 3 Days" EncounterWithSurgery,
  ["Procedure, Performed": "Removal of endotracheal tube (procedure)"] Extubation,
  "Noninvasive Oxygen Therapy" OxygenSupport
  let ExtubationTime: Global."NormalizeInterval" ( Extubation.relevantDatetime, Extubation.relevantPeriod ),
  AnesthesiaTime: Global."NormalizeInterval" ( "LatestGeneralAnesthesiaOrMAC"(Extubation).relevantDatetime, "LatestGeneralAnesthesiaOrMAC"(Extubation).relevantPeriod ),
  OxygenTime: Global."NormalizeInterval" ( OxygenSupport.relevantDatetime, OxygenSupport.relevantPeriod ),
  HospitalizationPeriod: Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( EncounterWithSurgery )
  where ExtubationTime starts during HospitalizationPeriod
    and ExtubationTime starts after AnesthesiaTime
    and OxygenTime starts during Interval[end of AnesthesiaTime, start of ExtubationTime]
  return Extubation

General Anesthesia and MAC

["Procedure, Performed": "Anesthesia Requiring Monitored Care"] MAC
  union ["Procedure, Performed": "General and Neuraxial Anesthesia"] GA

Initial Population

"Elective Inpatient Encounter with OR Procedure within 3 Days"

Intubation During General Anesthesia and MAC

from
  "Elective Inpatient Encounter with OR Procedure within 3 Days" EncounterWithSurgery,
  ["Procedure, Performed": "Intubation"] ProceduralIntubation,
  "General Anesthesia and MAC" ProcedureWithAnesthesia
  let IntubationTime: Global."NormalizeInterval" ( ProceduralIntubation.relevantDatetime, ProceduralIntubation.relevantPeriod ),
  AnesthesiaTime: Global."NormalizeInterval" ( ProcedureWithAnesthesia.relevantDatetime, ProcedureWithAnesthesia.relevantPeriod ),
  HospitalizationPeriod: Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( EncounterWithSurgery )
  where IntubationTime starts during AnesthesiaTime
    and IntubationTime starts during HospitalizationPeriod
  return ProceduralIntubation

Noninvasive Oxygen Therapy

"Noninvasive Oxygen Therapy Procedure"
  union "Noninvasive Oxygen Therapy Assessment"

Noninvasive Oxygen Therapy Assessment

["Assessment, Performed": "Non Invasive Oxygen Therapy"]

Noninvasive Oxygen Therapy Procedure

["Procedure, Performed": "Non Invasive Oxygen Therapy by Nasal Cannula or Mask"]

Numerator

"Encounter with Intubation Outside of Procedural Area within 30 Days of End of First OR Procedure"
  union "Encounter with Mechanical Ventilation Outside of Procedural Area within 30 Days of End of First OR Procedure and Preceded by Non Invasive Oxygen Therapy"
  union "Encounter with Extubation Outside of Procedural Area within 30 Days of End of First OR Procedure More Than 48 Hours After End of Anesthesia"
  union "Encounter with Mechanical Ventilation within 30 Days of End of First OR Procedure and Between 48 and 72 Hours After End of OR Procedure and not Preceded by Non Invasive Oxygen Therapy or Anesthesia"

Risk Variable All Encounter Diagnoses with POA Indication

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    diagnosis: QualifyingEncounter.diagnoses.code,
    POA: QualifyingEncounter.diagnoses.presentOnAdmissionIndicator
  }

Risk Variable ASA Physical Status Class

from
  ["Assessment, Performed": "American society of anesthesiologists morbidity state"] ASAclass
  with "Initial Population" QualifyingEncounter
    such that Global."NormalizeInterval" ( ASAclass.relevantDatetime, ASAclass.relevantPeriod ) starts during Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( QualifyingEncounter )
      and ASAclass.result is not null
      and ASAclass.result in "ASA physical status class"
  return ASAclass.result

Risk Variable Encounter Procedures

from
  ["Procedure, Performed"] Procedure,
  "Initial Population" QualifyingEncounter
  where Global."NormalizeInterval" ( Procedure.relevantDatetime, Procedure.relevantPeriod ) starts during Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( QualifyingEncounter )
  return {
    encounterId: QualifyingEncounter.id,
    procedureId: Procedure.id,
    procedurecode: Procedure.code,
    procedurerank: Procedure.rank,
    proceduretime: Global."NormalizeInterval" ( Procedure.relevantDatetime, Procedure.relevantPeriod )
  }

Risk Variable First Albumin in Encounter

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstAlbumin: "FirstAlbumin"(QualifyingEncounter)
  }

Risk Variable First Arterial pH in Encounter

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstArterialpH: "FirstArterialpH"(QualifyingEncounter)
  }

Risk Variable First AST in Encounter

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstAST: "FirstAST"(QualifyingEncounter)
  }

Risk Variable First Bicarbonate in Encounter

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstBicarbonate: "FirstBicarbonate"(QualifyingEncounter)
  }

Risk Variable First Bilirubin in Encounter

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstBilirubin: "FirstBilirubin"(QualifyingEncounter)
  }

Risk Variable First Blood Urea Nitrogen in Encounter

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstBUN: "FirstBloodUreaNitrogen"(QualifyingEncounter)
  }

Risk Variable First BMI

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstBMI: "FirstBMI"(QualifyingEncounter)
  }

Risk Variable First Body Temperature in Encounter

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstBodyTemp: "FirstBodyTemperature"(QualifyingEncounter)
  }

Risk Variable First Carbon Dioxide in Encounter

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstCarbonDioxide: "FirstCarbonDioxide"(QualifyingEncounter)
  }

Risk Variable First Creatinine in Encounter

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstCreatinine: "FirstCreatinine"(QualifyingEncounter)
  }

Risk Variable First Heart Rate in Encounter

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstHeartRate: "FirstHeartRate"(QualifyingEncounter)
  }

Risk Variable First Hematocrit in Encounter

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstHematocrit: "FirstHematocrit"(QualifyingEncounter)
  }

Risk Variable First Hemoglobin in Encounter

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstHemoglobin: "FirstHemoglobin"(QualifyingEncounter)
  }

Risk Variable First Leukocyte Count in Encounter

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstLeukocyte: "FirstLeukocyte"(QualifyingEncounter)
  }

Risk Variable First Oxygen in Encounter

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstOxygen: "FirstOxygen"(QualifyingEncounter)
  }

Risk Variable First Platelet Count in Encounter

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstPlatelet: "FirstPlatelet"(QualifyingEncounter)
  }

Risk Variable First Respiratory Rate in Encounter

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstRespiratoryRate: "FirstRespiratoryRate"(QualifyingEncounter)
  }

Risk Variable First Sodium in Encounter

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstSodium: "FirstSodium"(QualifyingEncounter)
  }

Risk Variable First Systolic Blood Pressure in Encounter

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstSystolic: "FirstSystolicBloodPressure"(QualifyingEncounter)
  }

Risk Variable First White Blood Cell Count in Encounter

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstWBCcount: "FirstWhiteBloodCellCount"(QualifyingEncounter)
  }

Risk Variable Principle Procedure

from
  ["Procedure, Performed"] Procedure,
  "Initial Population" QualifyingEncounter
  where Procedure.rank = 1
    and Global."NormalizeInterval" ( Procedure.relevantDatetime, Procedure.relevantPeriod ) starts during Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( QualifyingEncounter )
  return {
    encounterId: QualifyingEncounter.id,
    procedureId: Procedure.id,
    procedurecode: Procedure.code,
    procedurerank: Procedure.rank,
    proceduretime: Global."NormalizeInterval" ( Procedure.relevantDatetime, Procedure.relevantPeriod )
  }

Risk Variable Smoking Status

Last(["Assessment, Performed": "Tobacco smoking status"] SmokingStatus
    with "Initial Population" QualifyingEncounter
      such that(Global."LatestOf"(SmokingStatus.relevantDatetime, SmokingStatus.relevantPeriod) during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
          or Global."LatestOf"(SmokingStatus.relevantDatetime, SmokingStatus.relevantPeriod) before Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      )
        and SmokingStatus.result is not null
        and SmokingStatus.result in "Smoking status"
    sort by Global."LatestOf"(relevantDatetime, relevantPeriod)
).result

SDE Ethnicity

["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

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

SDE Race
- - ["Patient Characteristic Race": "Race"]

SDE Sex

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

FirstAlbumin(QualifyingEncounter "Encounter, Performed")

First(["Laboratory Test, Performed": "Albumin lab test"] FirstAlbuminTest
    where Global."EarliestOf"(FirstAlbuminTest.relevantDatetime, FirstAlbuminTest.relevantPeriod) during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and FirstAlbuminTest.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Quantity

FirstArterialpH(QualifyingEncounter "Encounter, Performed")

First(["Laboratory Test, Performed": "Arterial Blood pH"] FirstArterialpHTest
    where Global."EarliestOf"(FirstArterialpHTest.relevantDatetime, FirstArterialpHTest.relevantPeriod) during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and FirstArterialpHTest.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Quantity

FirstAST(QualifyingEncounter "Encounter, Performed")

First(["Laboratory Test, Performed": "Aspartate transaminase lab test"] FirstASTTest
    where Global."EarliestOf"(FirstASTTest.relevantDatetime, FirstASTTest.relevantPeriod) during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and FirstASTTest.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Quantity

FirstBicarbonate(QualifyingEncounter "Encounter, Performed")

First(["Laboratory Test, Performed": "Bicarbonate lab test"] FirstBicarbonateTest
    where Global."EarliestOf"(FirstBicarbonateTest.relevantDatetime, FirstBicarbonateTest.relevantPeriod) during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and FirstBicarbonateTest.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Quantity

FirstBilirubin(QualifyingEncounter "Encounter, Performed")

First(["Laboratory Test, Performed": "Bilirubin lab test"] FirstBilirubinTest
    where Global."EarliestOf"(FirstBilirubinTest.relevantDatetime, FirstBilirubinTest.relevantPeriod) during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and FirstBilirubinTest.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Quantity

FirstBloodUreaNitrogen(QualifyingEncounter "Encounter, Performed")

First(["Laboratory Test, Performed": "Blood urea nitrogen lab test"] FirstBUN
    where Global."EarliestOf"(FirstBUN.relevantDatetime, FirstBUN.relevantPeriod) during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and FirstBUN.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Quantity

FirstBMI(QualifyingEncounter "Encounter, Performed")

First(["Physical Exam, Performed": "Body mass index (BMI) [Ratio]"] FirstBodyMass
    where Global."EarliestOf"(FirstBodyMass.relevantDatetime, FirstBodyMass.relevantPeriod) during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and FirstBodyMass.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Quantity

FirstBodyTemperature(QualifyingEncounter "Encounter, Performed")

First(["Physical Exam, Performed": "Body temperature"] FirstTemperature
    where Global."EarliestOf"(FirstTemperature.relevantDatetime, FirstTemperature.relevantPeriod) during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and FirstTemperature.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Quantity

FirstCarbonDioxide(QualifyingEncounter "Encounter, Performed")

First(["Laboratory Test, Performed": "Carbon Dioxide Partial Pressure in Arterial Blood"] FirstCarbonDioxideTest
    where Global."EarliestOf"(FirstCarbonDioxideTest.relevantDatetime, FirstCarbonDioxideTest.relevantPeriod) during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and FirstCarbonDioxideTest.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Quantity

FirstCreatinine(QualifyingEncounter "Encounter, Performed")

First(["Laboratory Test, Performed": "Creatinine lab test"] FirstCreatinineTest
    where Global."EarliestOf"(FirstCreatinineTest.relevantDatetime, FirstCreatinineTest.relevantPeriod) during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and FirstCreatinineTest.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Quantity

FirstHeartRate(QualifyingEncounter "Encounter, Performed")

First(["Physical Exam, Performed": "Heart rate"] FirstHeartBeats
    where Global."EarliestOf"(FirstHeartBeats.relevantDatetime, FirstHeartBeats.relevantPeriod) during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and FirstHeartBeats.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Quantity

FirstHematocrit(QualifyingEncounter "Encounter, Performed")

First(["Laboratory Test, Performed": "Hematocrit lab test"] FirstHematocritTest
    where Global."EarliestOf"(FirstHematocritTest.relevantDatetime, FirstHematocritTest.relevantPeriod) during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and FirstHematocritTest.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Quantity

FirstHemoglobin(QualifyingEncounter "Encounter, Performed")

First(["Laboratory Test, Performed": "Hemoglobin lab test"] FirstHemoglobinTest
    where Global."EarliestOf"(FirstHemoglobinTest.relevantDatetime, FirstHemoglobinTest.relevantPeriod) during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and FirstHemoglobinTest.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Quantity

FirstLeukocyte(QualifyingEncounter "Encounter, Performed")

First(["Laboratory Test, Performed": "Leukocyte count lab test"] FirstLeukocyteCount
    where Global."EarliestOf"(FirstLeukocyteCount.relevantDatetime, FirstLeukocyteCount.relevantPeriod) during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and FirstLeukocyteCount.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Quantity

FirstOxygen(QualifyingEncounter "Encounter, Performed")

First(["Laboratory Test, Performed": "Oxygen Partial Pressure in Arterial Blood"] FirstOxygenTest
    where Global."EarliestOf"(FirstOxygenTest.relevantDatetime, FirstOxygenTest.relevantPeriod) during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and FirstOxygenTest.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Quantity

FirstPlatelet(QualifyingEncounter "Encounter, Performed")

First(["Laboratory Test, Performed": "Platelet count lab test"] FirstPlateletCount
    where Global."EarliestOf"(FirstPlateletCount.relevantDatetime, FirstPlateletCount.relevantPeriod) during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and FirstPlateletCount.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Quantity

FirstProcedure(Encounter "Encounter, Performed")

First("Anesthesia Procedure List" FirstORProcedure
    where Global."NormalizeInterval"(FirstORProcedure.relevantDatetime, FirstORProcedure.relevantPeriod) starts during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(Encounter)
    sort by start of Global."NormalizeInterval"(relevantDatetime, relevantPeriod)
)

FirstRespiratoryRate(QualifyingEncounter "Encounter, Performed")

First(["Physical Exam, Performed": "Respiratory rate"] FirstRespiration
    where Global."EarliestOf"(FirstRespiration.relevantDatetime, FirstRespiration.relevantPeriod) during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and FirstRespiration.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Quantity

FirstSodium(QualifyingEncounter "Encounter, Performed")

First(["Laboratory Test, Performed": "Sodium lab test"] FirstSodiumTest
    where Global."EarliestOf"(FirstSodiumTest.relevantDatetime, FirstSodiumTest.relevantPeriod) during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and FirstSodiumTest.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Quantity

FirstSystolicBloodPressure(QualifyingEncounter "Encounter, Performed")

First(["Physical Exam, Performed": "Systolic blood pressure"] FirstSystolic
    where Global."EarliestOf"(FirstSystolic.relevantDatetime, FirstSystolic.relevantPeriod) during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and FirstSystolic.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Quantity

FirstWhiteBloodCellCount(QualifyingEncounter "Encounter, Performed")

First(["Laboratory Test, Performed": "White blood cells count lab test"] FirstWBCCount
    where Global."EarliestOf"(FirstWBCCount.relevantDatetime, FirstWBCCount.relevantPeriod) during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and FirstWBCCount.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Quantity

LatestGeneralAnesthesiaOrMAC(Event "Procedure, Performed")

Last("General Anesthesia and MAC" ProcedureList
    where Global."NormalizeInterval"(ProcedureList.relevantDatetime, ProcedureList.relevantPeriod) ends before start of Global."NormalizeInterval"(Event.relevantDatetime, Event.relevantPeriod)
    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.HasEnd(period Interval<DateTime>)

not ( 
  end of period is null
    or 
    end of period = maximum DateTime
)

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.Latest(period Interval<DateTime>)

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

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

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>

code "American society of anesthesiologists morbidity state" ("LOINC Code (97816-3)")
code "Body mass index (BMI) [Ratio]" ("LOINC Code (39156-5)")
code "Body temperature" ("LOINC Code (8310-5)")
code "Elective (qualifier value)" ("SNOMEDCT Code (103390000)")
code "Heart rate" ("LOINC Code (8867-4)")
code "Removal of endotracheal tube (procedure)" ("SNOMEDCT Code (271280005)")
code "Respiratory rate" ("LOINC Code (9279-1)")
code "Systolic blood pressure" ("LOINC Code (8480-6)")
code "Tobacco smoking status" ("LOINC Code (72166-2)")
valueset "Acute Respiratory Failure" (2.16.840.1.113762.1.4.1248.88)
valueset "Albumin lab test" (2.16.840.1.113762.1.4.1248.221)
valueset "Anesthesia Requiring Monitored Care" (2.16.840.1.113762.1.4.1248.255)
valueset "Arterial Blood pH" (2.16.840.1.113762.1.4.1248.96)
valueset "ASA physical status class" (2.16.840.1.113762.1.4.1248.217)
valueset "Aspartate transaminase lab test" (2.16.840.1.113762.1.4.1248.224)
valueset "Bicarbonate lab test" (2.16.840.1.113762.1.4.1045.139)
valueset "Bilirubin lab test" (2.16.840.1.113762.1.4.1248.223)
valueset "Blood urea nitrogen lab test" (2.16.840.1.113762.1.4.1248.218)
valueset "Carbon Dioxide Partial Pressure in Arterial Blood" (2.16.840.1.113762.1.4.1248.95)
valueset "Creatinine lab test" (2.16.840.1.113883.3.666.5.2363)
valueset "Degenerative Neurological Disorder" (2.16.840.1.113762.1.4.1248.241)
valueset "Elective Inpatient Encounter" (2.16.840.1.113762.1.4.1248.85)
valueset "Emergency Department Visit" (2.16.840.1.113883.3.117.1.7.1.292)
valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
valueset "General and Neuraxial Anesthesia" (2.16.840.1.113762.1.4.1248.208)
valueset "Head, Neck, and Thoracic Surgeries with High Risk Airway Compromise" (2.16.840.1.113762.1.4.1248.251)
valueset "Hematocrit lab test" (2.16.840.1.113762.1.4.1045.114)
valueset "Hemoglobin lab test" (2.16.840.1.113762.1.4.1248.219)
valueset "Intubation" (2.16.840.1.113762.1.4.1248.179)
valueset "Leukocyte count lab test" (2.16.840.1.113762.1.4.1248.222)
valueset "Mechanical Ventilation" (2.16.840.1.113762.1.4.1248.107)
valueset "Neuromuscular Disorder" (2.16.840.1.113762.1.4.1248.239)
valueset "Non Invasive Oxygen Therapy" (2.16.840.1.113762.1.4.1248.213)
valueset "Non Invasive Oxygen Therapy by Nasal Cannula or Mask" (2.16.840.1.113762.1.4.1248.209)
valueset "Observation Services" (2.16.840.1.113762.1.4.1111.143)
valueset "Obstetrical or Pregnancy Related Conditions" (2.16.840.1.113883.3.117.1.7.1.263)
valueset "ONC Administrative Sex" (2.16.840.1.113762.1.4.1)
valueset "Outpatient Surgery Service" (2.16.840.1.113762.1.4.1110.38)
valueset "Oxygen Partial Pressure in Arterial Blood" (2.16.840.1.113762.1.4.1248.94)
valueset "Payer Type" (2.16.840.1.114222.4.11.3591)
valueset "Platelet count lab test" (2.16.840.1.113762.1.4.1045.127)
valueset "Present on Admission or Clinically Undetermined" (2.16.840.1.113762.1.4.1147.197)
valueset "Procedural Hospital Locations" (2.16.840.1.113762.1.4.1248.216)
valueset "Race" (2.16.840.1.114222.4.11.836)
valueset "Smoking status" (2.16.840.1.113762.1.4.1248.220)
valueset "Sodium lab test" (2.16.840.1.113762.1.4.1045.119)
valueset "Tracheostomy Diagnoses" (2.16.840.1.113762.1.4.1248.89)
valueset "Tracheostomy Procedures" (2.16.840.1.113762.1.4.1248.181)
valueset "White blood cells count lab test" (2.16.840.1.113762.1.4.1045.129)

"Assessment, Performed: American society of anesthesiologists morbidity state" using "American society of anesthesiologists morbidity state (LOINC Code 97816-3)"
"Assessment, Performed: Non Invasive Oxygen Therapy" using "Non Invasive Oxygen Therapy (2.16.840.1.113762.1.4.1248.213)"
"Assessment, Performed: Tobacco smoking status" using "Tobacco smoking status (LOINC Code 72166-2)"
"Encounter, Performed: Elective Inpatient Encounter" using "Elective Inpatient Encounter (2.16.840.1.113762.1.4.1248.85)"
"Encounter, Performed: Emergency Department Visit" using "Emergency Department Visit (2.16.840.1.113883.3.117.1.7.1.292)"
"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: Albumin lab test" using "Albumin lab test (2.16.840.1.113762.1.4.1248.221)"
"Laboratory Test, Performed: Arterial Blood pH" using "Arterial Blood pH (2.16.840.1.113762.1.4.1248.96)"
"Laboratory Test, Performed: Aspartate transaminase lab test" using "Aspartate transaminase lab test (2.16.840.1.113762.1.4.1248.224)"
"Laboratory Test, Performed: Bicarbonate lab test" using "Bicarbonate lab test (2.16.840.1.113762.1.4.1045.139)"
"Laboratory Test, Performed: Bilirubin lab test" using "Bilirubin lab test (2.16.840.1.113762.1.4.1248.223)"
"Laboratory Test, Performed: Blood urea nitrogen lab test" using "Blood urea nitrogen lab test (2.16.840.1.113762.1.4.1248.218)"
"Laboratory Test, Performed: Carbon Dioxide Partial Pressure in Arterial Blood" using "Carbon Dioxide Partial Pressure in Arterial Blood (2.16.840.1.113762.1.4.1248.95)"
"Laboratory Test, Performed: Creatinine lab test" using "Creatinine lab test (2.16.840.1.113883.3.666.5.2363)"
"Laboratory Test, Performed: Hematocrit lab test" using "Hematocrit lab test (2.16.840.1.113762.1.4.1045.114)"
"Laboratory Test, Performed: Hemoglobin lab test" using "Hemoglobin lab test (2.16.840.1.113762.1.4.1248.219)"
"Laboratory Test, Performed: Leukocyte count lab test" using "Leukocyte count lab test (2.16.840.1.113762.1.4.1248.222)"
"Laboratory Test, Performed: Oxygen Partial Pressure in Arterial Blood" using "Oxygen Partial Pressure in Arterial Blood (2.16.840.1.113762.1.4.1248.94)"
"Laboratory Test, Performed: Platelet count lab test" using "Platelet count lab test (2.16.840.1.113762.1.4.1045.127)"
"Laboratory Test, Performed: Sodium lab test" using "Sodium lab test (2.16.840.1.113762.1.4.1045.119)"
"Laboratory Test, Performed: White blood cells count lab test" using "White blood cells count lab test (2.16.840.1.113762.1.4.1045.129)"
"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: ONC Administrative Sex" using "ONC Administrative Sex (2.16.840.1.113762.1.4.1)"
"Physical Exam, Performed: Body mass index (BMI) [Ratio]" using "Body mass index (BMI) [Ratio] (LOINC Code 39156-5)"
"Physical Exam, Performed: Body temperature" using "Body temperature (LOINC Code 8310-5)"
"Physical Exam, Performed: Heart rate" using "Heart rate (LOINC Code 8867-4)"
"Physical Exam, Performed: Respiratory rate" using "Respiratory rate (LOINC Code 9279-1)"
"Physical Exam, Performed: Systolic blood pressure" using "Systolic blood pressure (LOINC Code 8480-6)"
"Procedure, Performed: Anesthesia Requiring Monitored Care" using "Anesthesia Requiring Monitored Care (2.16.840.1.113762.1.4.1248.255)"
"Procedure, Performed: General and Neuraxial Anesthesia" using "General and Neuraxial Anesthesia (2.16.840.1.113762.1.4.1248.208)"
"Procedure, Performed: Head, Neck, and Thoracic Surgeries with High Risk Airway Compromise" using "Head, Neck, and Thoracic Surgeries with High Risk Airway Compromise (2.16.840.1.113762.1.4.1248.251)"
"Procedure, Performed: Intubation" using "Intubation (2.16.840.1.113762.1.4.1248.179)"
"Procedure, Performed: Mechanical Ventilation" using "Mechanical Ventilation (2.16.840.1.113762.1.4.1248.107)"
"Procedure, Performed: Non Invasive Oxygen Therapy by Nasal Cannula or Mask" using "Non Invasive Oxygen Therapy by Nasal Cannula or Mask (2.16.840.1.113762.1.4.1248.209)"
"Procedure, Performed: Removal of endotracheal tube (procedure)" using "Removal of endotracheal tube (procedure) (SNOMEDCT Code 271280005)"
"Procedure, Performed: Tracheostomy Procedures" using "Tracheostomy Procedures (2.16.840.1.113762.1.4.1248.181)"

["Patient Characteristic Ethnicity": "Ethnicity"]

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

```
["Patient Characteristic Race": "Race"]
```

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

from
  ["Assessment, Performed": "American society of anesthesiologists morbidity state"] ASAclass
  with "Initial Population" QualifyingEncounter
    such that Global."NormalizeInterval" ( ASAclass.relevantDatetime, ASAclass.relevantPeriod ) starts during Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( QualifyingEncounter )
      and ASAclass.result is not null
      and ASAclass.result in "ASA physical status class"
  return ASAclass.result

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    diagnosis: QualifyingEncounter.diagnoses.code,
    POA: QualifyingEncounter.diagnoses.presentOnAdmissionIndicator
  }

from
  ["Procedure, Performed"] Procedure,
  "Initial Population" QualifyingEncounter
  where Global."NormalizeInterval" ( Procedure.relevantDatetime, Procedure.relevantPeriod ) starts during Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( QualifyingEncounter )
  return {
    encounterId: QualifyingEncounter.id,
    procedureId: Procedure.id,
    procedurecode: Procedure.code,
    procedurerank: Procedure.rank,
    proceduretime: Global."NormalizeInterval" ( Procedure.relevantDatetime, Procedure.relevantPeriod )
  }

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstAST: "FirstAST"(QualifyingEncounter)
  }

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstAlbumin: "FirstAlbumin"(QualifyingEncounter)
  }

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstArterialpH: "FirstArterialpH"(QualifyingEncounter)
  }

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstBMI: "FirstBMI"(QualifyingEncounter)
  }

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstBicarbonate: "FirstBicarbonate"(QualifyingEncounter)
  }

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstBilirubin: "FirstBilirubin"(QualifyingEncounter)
  }

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstBUN: "FirstBloodUreaNitrogen"(QualifyingEncounter)
  }

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstBodyTemp: "FirstBodyTemperature"(QualifyingEncounter)
  }

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstCarbonDioxide: "FirstCarbonDioxide"(QualifyingEncounter)
  }

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstCreatinine: "FirstCreatinine"(QualifyingEncounter)
  }

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstHeartRate: "FirstHeartRate"(QualifyingEncounter)
  }

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstHematocrit: "FirstHematocrit"(QualifyingEncounter)
  }

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstHemoglobin: "FirstHemoglobin"(QualifyingEncounter)
  }

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstLeukocyte: "FirstLeukocyte"(QualifyingEncounter)
  }

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstOxygen: "FirstOxygen"(QualifyingEncounter)
  }

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstPlatelet: "FirstPlatelet"(QualifyingEncounter)
  }

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstRespiratoryRate: "FirstRespiratoryRate"(QualifyingEncounter)
  }

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstSodium: "FirstSodium"(QualifyingEncounter)
  }

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstSystolic: "FirstSystolicBloodPressure"(QualifyingEncounter)
  }

"Initial Population" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstWBCcount: "FirstWhiteBloodCellCount"(QualifyingEncounter)
  }

from
  ["Procedure, Performed"] Procedure,
  "Initial Population" QualifyingEncounter
  where Procedure.rank = 1
    and Global."NormalizeInterval" ( Procedure.relevantDatetime, Procedure.relevantPeriod ) starts during Global."HospitalizationWithObservationAndOutpatientSurgeryService" ( QualifyingEncounter )
  return {
    encounterId: QualifyingEncounter.id,
    procedureId: Procedure.id,
    procedurecode: Procedure.code,
    procedurerank: Procedure.rank,
    proceduretime: Global."NormalizeInterval" ( Procedure.relevantDatetime, Procedure.relevantPeriod )
  }

Last(["Assessment, Performed": "Tobacco smoking status"] SmokingStatus
    with "Initial Population" QualifyingEncounter
      such that(Global."LatestOf"(SmokingStatus.relevantDatetime, SmokingStatus.relevantPeriod) during Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
          or Global."LatestOf"(SmokingStatus.relevantDatetime, SmokingStatus.relevantPeriod) before Global."HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      )
        and SmokingStatus.result is not null
        and SmokingStatus.result in "Smoking status"
    sort by Global."LatestOf"(relevantDatetime, relevantPeriod)
).result

Hospital Harm - Postoperative Respiratory Failure

Table of Contents

Population Criteria

Definitions

Functions

Terminology

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables