Prophylactic Antibiotic Selection for Surgical Patients

------ Population Criteria 1 ------

Initial Patient Population 1 =
- AND: "Patient Characteristic Birthdate: birth date" >= 18 year(s) starts before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
- AND: "Occurrence A of Encounter, Performed: Encounter Inpatient (length of stay <= 120 day(s))"
- AND: "Occurrence A of Encounter, Performed: Encounter Inpatient" ends during "Measurement Period"
- AND: "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
- AND: "Occurrence A of Procedure, Performed: SCIP Major Surgical Procedure (ordinality: 'Principal')" during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator 1 =
- AND: "Initial Patient Population 1"
- AND: "Occurrence A of Procedure, Performed: Hospital measures-CABG (ordinality: 'Principal')" during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator Exclusions 1 =
- AND:
  - OR:
    - AND: "Occurrence A of Diagnosis, Active: Any Infection Prior to Anesthesia Concepts" starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
    - AND NOT: "Occurrence A of Diagnosis, Active: Any Infection Prior to Anesthesia Concepts" ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Occurrence A of Patient Characteristic Clinical Trial Participant: Clinical Trial Participant" starts before or during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Occurrence A of Patient Characteristic Clinical Trial Participant: Clinical Trial Participant" ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - AND: "Patient Characteristic Expired: Expired" starts after start of "Occurrence A of Procedure, Performed: Hospital measures-CABG (incision datetime)"
    - AND NOT: "Patient Characteristic Expired: Expired" >= 6 hour(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Medication, Administered: IM or PO Antimicrobial medications (route: 'IM or PO route')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Medication, Administered: IV Antimicrobial medication (route: 'Hospital measures-Route IV')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - AND: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" > 1440 minute(s) starts before start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
    - AND:
      - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)"
      - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" starts after start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
  - OR:
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)"
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" starts after start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
  - OR:
    - AND: "Medication, Active: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 24 hour(s) starts before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR: "Procedure, Performed: Hospital measures-Pacemaker or implantable defibrillator insertion procedure" <= 4 day(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Procedure, Performed: Hospital measures-Pacemaker or implantable defibrillator insertion procedure" <= 4 day(s) ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence B of Procedure, Performed: General or Neuraxial Anesthesia" <= 4 day(s) ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence B of Procedure, Performed: General or Neuraxial Anesthesia" <= 4 day(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence A of Diagnosis, Active: Hospital Measures - Any infection (ordinality: 'Principal')" during "Encounter, Performed: Encounter Inpatient"
Numerator 1 =
- AND:
  - OR:
    - AND: "Medication, Allergy: Hospital Measures-Beta lactams for allergy determination" starts before start of "Occurrence A of Procedure, Performed: Hospital measures-CABG"
    - AND:
      - OR: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')"
      - OR: "Medication, Administered: Hospital Measures-IV Clindamycin (route: 'Hospital measures-Route IV')"
      - <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')" <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
    - AND:
      - OR: "Encounter, Performed: Encounter Inpatient (discharge datetime)" <= 1 year(s) ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
      - OR: "Procedure, Performed: Hospital measures-Hemodialysis or peritoneal dialysis" <= 1 year(s) starts before start of "Occurrence A of Procedure, Performed: Hospital measures-CABG (incision datetime)"
      - OR: "Occurrence A of Encounter, Performed: Encounter Inpatient (admission datetime)" > 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: Hospital measures-CABG (incision datetime)"
      - OR:
        
        AND: "Occurrence A of Diagnosis, Active: Hospital Measures-MRSA Colonization or Infection" starts before start of "Occurrence A of Procedure, Performed: Hospital measures-CABG (incision datetime)"
        
        AND NOT: "Occurrence A of Diagnosis, Active: Hospital Measures-MRSA Colonization or Infection" ends before start of "Occurrence A of Procedure, Performed: Hospital measures-CABG (incision datetime)"
      - OR:
        
        AND: "Occurrence A of Intervention, Performed: Hospital Measures-Chronic Wound Care" starts before start of "Occurrence A of Procedure, Performed: Hospital measures-CABG (incision datetime)"
        
        AND NOT: "Occurrence A of Intervention, Performed: Hospital Measures-Chronic Wound Care" ends before start of "Occurrence A of Procedure, Performed: Hospital measures-CABG (incision datetime)"
      - OR:
        
        AND: "Occurrence A of Procedure, Performed: Hospital Measures-Cardiac Valve Surgery" starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
        
        AND: "Occurrence A of Procedure, Performed: Hospital Measures-Cardiac Valve Surgery" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
      - OR:
        
        AND: "Transfer From: Hospital Measures-Acute care hospital"
        
        AND: "Encounter, Performed: Hospital measures-Acute care hospital encounter (length of stay >= 3 day(s))"
        
        < 24 hour(s) ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - OR: "Medication, Administered: Cefuroxime and Cefazolin Antibiotics for IV Administration (route: 'Hospital measures-Route IV')"
    - OR:
      - AND: "Medication, Order: Hospital measures-IV Vancomycin (reason: 'Hospital measures - Request of physician')"
      - AND: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')"
    - <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator Exceptions 1=
- None

------ Population Criteria 2 ------

Initial Patient Population 2 =
- AND: "Patient Characteristic Birthdate: birth date" >= 18 year(s) starts before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
- AND: "Occurrence A of Encounter, Performed: Encounter Inpatient (length of stay <= 120 day(s))"
- AND: "Occurrence A of Encounter, Performed: Encounter Inpatient" ends during "Measurement Period"
- AND: "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
- AND: "Occurrence A of Procedure, Performed: SCIP Major Surgical Procedure (ordinality: 'Principal')" during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator 2 =
- AND: "Initial Patient Population 2"
- AND: "Occurrence A of Procedure, Performed: Hospital measures-Other Cardiac Surgery (ordinality: 'Principal')" during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator Exclusions 2 =
- AND:
  - OR:
    - AND: "Occurrence A of Diagnosis, Active: Any Infection Prior to Anesthesia Concepts" starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
    - AND NOT: "Occurrence A of Diagnosis, Active: Any Infection Prior to Anesthesia Concepts" ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Occurrence A of Patient Characteristic Clinical Trial Participant: Clinical Trial Participant" starts before or during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Occurrence A of Patient Characteristic Clinical Trial Participant: Clinical Trial Participant" ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - AND: "Patient Characteristic Expired: Expired" starts after start of "Occurrence A of Procedure, Performed: Hospital measures-Other Cardiac Surgery (incision datetime)"
    - AND NOT: "Patient Characteristic Expired: Expired" >= 6 hour(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Medication, Administered: IM or PO Antimicrobial medications (route: 'IM or PO route')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Medication, Administered: IV Antimicrobial medication (route: 'Hospital measures-Route IV')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - AND: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" > 1440 minute(s) starts before start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
    - AND:
      - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)"
      - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" starts after start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
  - OR:
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)"
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" starts after start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
  - OR:
    - AND: "Medication, Active: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 24 hour(s) starts before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR: "Procedure, Performed: Hospital measures-Pacemaker or implantable defibrillator insertion procedure" <= 4 day(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Procedure, Performed: Hospital measures-Pacemaker or implantable defibrillator insertion procedure" <= 4 day(s) ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence B of Procedure, Performed: General or Neuraxial Anesthesia" <= 4 day(s) ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence B of Procedure, Performed: General or Neuraxial Anesthesia" <= 4 day(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence A of Diagnosis, Active: Hospital Measures - Any infection (ordinality: 'Principal')" during "Encounter, Performed: Encounter Inpatient"
Numerator 2 =
- AND:
  - OR:
    - AND: "Medication, Allergy: Hospital Measures-Beta lactams for allergy determination" starts before start of "Occurrence A of Procedure, Performed: Hospital measures-Other Cardiac Surgery"
    - AND:
      - OR: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')"
      - OR: "Medication, Administered: Hospital Measures-IV Clindamycin (route: 'Hospital measures-Route IV')"
      - <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')" <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
    - AND:
      - OR: "Encounter, Performed: Encounter Inpatient (discharge datetime)" <= 1 year(s) ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
      - OR: "Procedure, Performed: Hospital measures-Hemodialysis or peritoneal dialysis" <= 1 year(s) starts before start of "Occurrence A of Procedure, Performed: Hospital measures-Other Cardiac Surgery (incision datetime)"
      - OR: "Occurrence A of Encounter, Performed: Encounter Inpatient (admission datetime)" > 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: Hospital measures-Other Cardiac Surgery (incision datetime)"
      - OR:
        
        AND: "Occurrence A of Diagnosis, Active: Hospital Measures-MRSA Colonization or Infection" starts before start of "Occurrence A of Procedure, Performed: Hospital measures-Other Cardiac Surgery (incision datetime)"
        
        AND NOT: "Occurrence A of Diagnosis, Active: Hospital Measures-MRSA Colonization or Infection" ends before start of "Occurrence A of Procedure, Performed: Hospital measures-Other Cardiac Surgery (incision datetime)"
      - OR:
        
        AND: "Occurrence A of Intervention, Performed: Hospital Measures-Chronic Wound Care" starts before start of "Occurrence A of Procedure, Performed: Hospital measures-Other Cardiac Surgery (incision datetime)"
        
        AND NOT: "Occurrence A of Intervention, Performed: Hospital Measures-Chronic Wound Care" ends before start of "Occurrence A of Procedure, Performed: Hospital measures-Other Cardiac Surgery (incision datetime)"
      - OR:
        
        AND: "Occurrence A of Procedure, Performed: Hospital Measures-Cardiac Valve Surgery" starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
        
        AND: "Occurrence A of Procedure, Performed: Hospital Measures-Cardiac Valve Surgery" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
      - OR:
        
        AND: "Transfer From: Hospital Measures-Acute care hospital"
        
        AND: "Encounter, Performed: Hospital measures-Acute care hospital encounter (length of stay >= 3 day(s))"
        
        < 24 hour(s) ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - OR: "Medication, Administered: Cefuroxime and Cefazolin Antibiotics for IV Administration (route: 'Hospital measures-Route IV')"
    - OR:
      - AND: "Medication, Order: Hospital measures-IV Vancomycin (reason: 'Hospital measures - Request of physician')"
      - AND: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')"
    - <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator Exceptions 2=
- None

------ Population Criteria 3 ------

Initial Patient Population 3 =
- AND: "Patient Characteristic Birthdate: birth date" >= 18 year(s) starts before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
- AND: "Occurrence A of Encounter, Performed: Encounter Inpatient (length of stay <= 120 day(s))"
- AND: "Occurrence A of Encounter, Performed: Encounter Inpatient" ends during "Measurement Period"
- AND: "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
- AND: "Occurrence A of Procedure, Performed: SCIP Major Surgical Procedure (ordinality: 'Principal')" during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator 3 =
- AND: "Initial Patient Population 3"
- AND: "Occurrence A of Procedure, Performed: Hospital measures-Hip arthroplasty (ordinality: 'Principal')" during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator Exclusions 3 =
- AND:
  - OR:
    - AND: "Occurrence A of Diagnosis, Active: Any Infection Prior to Anesthesia Concepts" starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
    - AND NOT: "Occurrence A of Diagnosis, Active: Any Infection Prior to Anesthesia Concepts" ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Occurrence A of Patient Characteristic Clinical Trial Participant: Clinical Trial Participant" starts before or during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Occurrence A of Patient Characteristic Clinical Trial Participant: Clinical Trial Participant" ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - AND: "Patient Characteristic Expired: Expired" starts after start of "Occurrence A of Procedure, Performed: Hospital measures-Hip arthroplasty (incision datetime)"
    - AND NOT: "Patient Characteristic Expired: Expired" >= 6 hour(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Medication, Administered: IM or PO Antimicrobial medications (route: 'IM or PO route')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Medication, Administered: IV Antimicrobial medication (route: 'Hospital measures-Route IV')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - AND: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" > 1440 minute(s) starts before start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
    - AND:
      - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)"
      - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" starts after start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
  - OR:
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)"
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" starts after start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
  - OR:
    - AND: "Medication, Active: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 24 hour(s) starts before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR: "Procedure, Performed: Hospital measures-Pacemaker or implantable defibrillator insertion procedure" <= 3 day(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Procedure, Performed: Hospital measures-Pacemaker or implantable defibrillator insertion procedure" <= 3 day(s) ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence B of Procedure, Performed: General or Neuraxial Anesthesia" <= 3 day(s) ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence B of Procedure, Performed: General or Neuraxial Anesthesia" <= 3 day(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence A of Diagnosis, Active: Hospital Measures - Any infection (ordinality: 'Principal')" during "Encounter, Performed: Encounter Inpatient"
Numerator 3 =
- AND:
  - OR:
    - AND: "Medication, Allergy: Hospital Measures-Beta lactams for allergy determination" starts before start of "Occurrence A of Procedure, Performed: Hospital measures-Hip arthroplasty"
    - AND:
      - OR: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')"
      - OR: "Medication, Administered: Hospital Measures-IV Clindamycin (route: 'Hospital measures-Route IV')"
      - <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')" <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
    - AND:
      - OR: "Encounter, Performed: Encounter Inpatient (discharge datetime)" <= 1 year(s) ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
      - OR: "Procedure, Performed: Hospital measures-Hemodialysis or peritoneal dialysis" <= 1 year(s) starts before start of "Occurrence A of Procedure, Performed: Hospital measures-Hip arthroplasty (incision datetime)"
      - OR: "Occurrence A of Encounter, Performed: Encounter Inpatient (admission datetime)" > 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: Hospital measures-Hip arthroplasty (incision datetime)"
      - OR:
        
        AND: "Occurrence A of Diagnosis, Active: Hospital Measures-MRSA Colonization or Infection" starts before start of "Occurrence A of Procedure, Performed: Hospital measures-Hip arthroplasty (incision datetime)"
        
        AND NOT: "Occurrence A of Diagnosis, Active: Hospital Measures-MRSA Colonization or Infection" ends before start of "Occurrence A of Procedure, Performed: Hospital measures-Hip arthroplasty (incision datetime)"
      - OR:
        
        AND: "Occurrence A of Intervention, Performed: Hospital Measures-Chronic Wound Care" starts before start of "Occurrence A of Procedure, Performed: Hospital measures-Hip arthroplasty (incision datetime)"
        
        AND NOT: "Occurrence A of Intervention, Performed: Hospital Measures-Chronic Wound Care" ends before start of "Occurrence A of Procedure, Performed: Hospital measures-Hip arthroplasty (incision datetime)"
      - OR:
        
        AND: "Occurrence A of Procedure, Performed: Hospital Measures-Cardiac Valve Surgery" starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
        
        AND: "Occurrence A of Procedure, Performed: Hospital Measures-Cardiac Valve Surgery" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
      - OR:
        
        AND: "Transfer From: Hospital Measures-Acute care hospital"
        
        AND: "Encounter, Performed: Hospital measures-Acute care hospital encounter (length of stay >= 3 day(s))"
        
        < 24 hour(s) ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - OR: "Medication, Administered: Cefuroxime and Cefazolin Antibiotics for IV Administration (route: 'Hospital measures-Route IV')"
    - OR:
      - AND: "Medication, Order: Hospital measures-IV Vancomycin (reason: 'Hospital measures - Request of physician')"
      - AND: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')"
    - <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator Exceptions 3=
- None

------ Population Criteria 4 ------

Initial Patient Population 4 =
- AND: "Patient Characteristic Birthdate: birth date" >= 18 year(s) starts before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
- AND: "Occurrence A of Encounter, Performed: Encounter Inpatient (length of stay <= 120 day(s))"
- AND: "Occurrence A of Encounter, Performed: Encounter Inpatient" ends during "Measurement Period"
- AND: "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
- AND: "Occurrence A of Procedure, Performed: SCIP Major Surgical Procedure (ordinality: 'Principal')" during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator 4 =
- AND: "Initial Patient Population 4"
- AND: "Occurrence A of Procedure, Performed: Hospital measures-Knee arthroplasty (ordinality: 'Principal')" during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator Exclusions 4 =
- AND:
  - OR:
    - AND: "Occurrence A of Diagnosis, Active: Any Infection Prior to Anesthesia Concepts" starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
    - AND NOT: "Occurrence A of Diagnosis, Active: Any Infection Prior to Anesthesia Concepts" ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Occurrence A of Patient Characteristic Clinical Trial Participant: Clinical Trial Participant" starts before or during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Occurrence A of Patient Characteristic Clinical Trial Participant: Clinical Trial Participant" ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - AND: "Patient Characteristic Expired: Expired" starts after start of "Occurrence A of Procedure, Performed: Hospital measures-Knee arthroplasty (incision datetime)"
    - AND NOT: "Patient Characteristic Expired: Expired" >= 6 hour(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Medication, Administered: IM or PO Antimicrobial medications (route: 'IM or PO route')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Medication, Administered: IV Antimicrobial medication (route: 'Hospital measures-Route IV')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - AND: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" > 1440 minute(s) starts before start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
    - AND:
      - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)"
      - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" starts after start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
  - OR:
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)"
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" starts after start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
  - OR:
    - AND: "Medication, Active: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 24 hour(s) starts before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR: "Procedure, Performed: Hospital measures-Pacemaker or implantable defibrillator insertion procedure" <= 3 day(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Procedure, Performed: Hospital measures-Pacemaker or implantable defibrillator insertion procedure" <= 3 day(s) ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence B of Procedure, Performed: General or Neuraxial Anesthesia" <= 3 day(s) ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence B of Procedure, Performed: General or Neuraxial Anesthesia" <= 3 day(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence A of Diagnosis, Active: Hospital Measures - Any infection (ordinality: 'Principal')" during "Encounter, Performed: Encounter Inpatient"
Numerator 4 =
- AND:
  - OR:
    - AND: "Medication, Allergy: Hospital Measures-Beta lactams for allergy determination" starts before start of "Occurrence A of Procedure, Performed: Hospital measures-Knee arthroplasty"
    - AND:
      - OR: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')"
      - OR: "Medication, Administered: Hospital Measures-IV Clindamycin (route: 'Hospital measures-Route IV')"
      - <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')" <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
    - AND:
      - OR: "Encounter, Performed: Encounter Inpatient (discharge datetime)" <= 1 year(s) ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
      - OR: "Procedure, Performed: Hospital measures-Hemodialysis or peritoneal dialysis" <= 1 year(s) starts before start of "Occurrence A of Procedure, Performed: Hospital measures-Knee arthroplasty (incision datetime)"
      - OR: "Occurrence A of Encounter, Performed: Encounter Inpatient (admission datetime)" > 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: Hospital measures-Knee arthroplasty (incision datetime)"
      - OR:
        
        AND: "Occurrence A of Diagnosis, Active: Hospital Measures-MRSA Colonization or Infection" starts before start of "Occurrence A of Procedure, Performed: Hospital measures-Knee arthroplasty (incision datetime)"
        
        AND NOT: "Occurrence A of Diagnosis, Active: Hospital Measures-MRSA Colonization or Infection" ends before start of "Occurrence A of Procedure, Performed: Hospital measures-Knee arthroplasty (incision datetime)"
      - OR:
        
        AND: "Occurrence A of Intervention, Performed: Hospital Measures-Chronic Wound Care" starts before start of "Occurrence A of Procedure, Performed: Hospital measures-Knee arthroplasty (incision datetime)"
        
        AND NOT: "Occurrence A of Intervention, Performed: Hospital Measures-Chronic Wound Care" ends before start of "Occurrence A of Procedure, Performed: Hospital measures-Knee arthroplasty (incision datetime)"
      - OR:
        
        AND: "Occurrence A of Procedure, Performed: Hospital Measures-Cardiac Valve Surgery" starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
        
        AND: "Occurrence A of Procedure, Performed: Hospital Measures-Cardiac Valve Surgery" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
      - OR:
        
        AND: "Transfer From: Hospital Measures-Acute care hospital"
        
        AND: "Encounter, Performed: Hospital measures-Acute care hospital encounter (length of stay >= 3 day(s))"
        
        < 24 hour(s) ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - OR: "Medication, Administered: Cefuroxime and Cefazolin Antibiotics for IV Administration (route: 'Hospital measures-Route IV')"
    - OR:
      - AND: "Medication, Order: Hospital measures-IV Vancomycin (reason: 'Hospital measures - Request of physician')"
      - AND: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')"
    - <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator Exceptions 4=
- None

------ Population Criteria 5 ------

Initial Patient Population 5 =
- AND: "Patient Characteristic Birthdate: birth date" >= 18 year(s) starts before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
- AND: "Occurrence A of Encounter, Performed: Encounter Inpatient (length of stay <= 120 day(s))"
- AND: "Occurrence A of Encounter, Performed: Encounter Inpatient" ends during "Measurement Period"
- AND: "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
- AND: "Occurrence A of Procedure, Performed: SCIP Major Surgical Procedure (ordinality: 'Principal')" during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator 5 =
- AND: "Initial Patient Population 5"
- AND: "Occurrence A of Procedure, Performed: Hospital measures- Colon surgery (ordinality: 'Principal')" during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator Exclusions 5 =
- AND:
  - OR:
    - AND: "Occurrence A of Diagnosis, Active: Any Infection Prior to Anesthesia Concepts" starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
    - AND NOT: "Occurrence A of Diagnosis, Active: Any Infection Prior to Anesthesia Concepts" ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Occurrence A of Patient Characteristic Clinical Trial Participant: Clinical Trial Participant" starts before or during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Occurrence A of Patient Characteristic Clinical Trial Participant: Clinical Trial Participant" ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - AND: "Patient Characteristic Expired: Expired" starts after start of "Occurrence A of Procedure, Performed: Hospital measures- Colon surgery (incision datetime)"
    - AND NOT: "Patient Characteristic Expired: Expired" >= 6 hour(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Medication, Administered: IM or PO Antimicrobial medications (route: 'IM or PO route')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Medication, Administered: IV Antimicrobial medication (route: 'Hospital measures-Route IV')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - AND: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" > 1440 minute(s) starts before start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
    - AND:
      - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)"
      - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" starts after start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
  - OR:
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)"
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" starts after start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
  - OR:
    - AND: "Medication, Active: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 24 hour(s) starts before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR: "Procedure, Performed: Hospital measures-Pacemaker or implantable defibrillator insertion procedure" <= 3 day(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Procedure, Performed: Hospital measures-Pacemaker or implantable defibrillator insertion procedure" <= 3 day(s) ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence B of Procedure, Performed: General or Neuraxial Anesthesia" <= 3 day(s) ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence B of Procedure, Performed: General or Neuraxial Anesthesia" <= 3 day(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence A of Diagnosis, Active: Hospital Measures - Any infection (ordinality: 'Principal')" during "Encounter, Performed: Encounter Inpatient"
Numerator 5 =
- AND:
  - OR:
    - AND: "Medication, Allergy: Hospital Measures-Beta lactams for allergy determination" starts before start of "Occurrence A of Procedure, Performed: Hospital measures- Colon surgery"
    - AND:
      - OR:
        
        AND: "Medication, Administered: Hospital Measures-IV Clindamycin (route: 'Hospital measures-Route IV')"
        
        AND: "Medication, Administered: Hospital Measures-IV Aminoglycosides (route: 'Hospital measures-Route IV')"
        
        <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
      - OR:
        
        AND: "Medication, Administered: Hospital Measures-IV Clindamycin (route: 'Hospital measures-Route IV')"
        
        AND: "Medication, Administered: Hospital Measures-IV Hysterectomy and Colon Quinolones (route: 'Hospital measures-Route IV')"
        
        <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
      - OR:
        
        AND: "Medication, Administered: Hospital Measures-IV Clindamycin (route: 'Hospital measures-Route IV')"
        
        AND: "Medication, Administered: Hospital Measures-IV Aztreonam (route: 'Hospital measures-Route IV')"
        
        <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
      - OR:
        
        AND: "Medication, Administered: Hospital Measures-IV Metronidazole (route: 'Hospital measures-Route IV')"
        
        AND: "Medication, Administered: Hospital Measures-IV Aminoglycosides (route: 'Hospital measures-Route IV')"
        
        <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
      - OR:
        
        AND: "Medication, Administered: Hospital Measures-IV Metronidazole (route: 'Hospital measures-Route IV')"
        
        AND: "Medication, Administered: Hospital Measures-IV Hysterectomy and Colon Quinolones (route: 'Hospital measures-Route IV')"
        
        <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - OR: "Medication, Administered: Hospital Measures-IV Colon-Antibiotics (route: 'Hospital measures-Route IV')"
    - OR: "Medication, Administered: Hospital Measures-IV Ertapenem (route: 'Hospital measures-Route IV')"
    - <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Medication, Administered: IV Cefazolin (route: 'Hospital measures-Route IV')"
    - AND: "Medication, Administered: Hospital Measures-IV Metronidazole (route: 'Hospital measures-Route IV')"
    - <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Medication, Administered: Hospital Measures-IV Metronidazole (route: 'Hospital measures-Route IV')"
    - AND: "Medication, Administered: IV Ceftriaxone (route: 'Hospital measures-Route IV')"
    - <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Medication, Administered: Hospital Measures-IV Metronidazole (route: 'Hospital measures-Route IV')"
    - AND: "Medication, Administered: IV Cefuroxime (route: 'Hospital measures-Route IV')"
    - <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)"
Denominator Exceptions 5=
- None

------ Population Criteria 6 ------

Initial Patient Population 6 =
- AND: "Patient Characteristic Birthdate: birth date" >= 18 year(s) starts before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
- AND: "Occurrence A of Encounter, Performed: Encounter Inpatient (length of stay <= 120 day(s))"
- AND: "Occurrence A of Encounter, Performed: Encounter Inpatient" ends during "Measurement Period"
- AND: "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
- AND: "Occurrence A of Procedure, Performed: SCIP Major Surgical Procedure (ordinality: 'Principal')" during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator 6 =
- AND: "Initial Patient Population 6"
- AND: "Occurrence A of Procedure, Performed: Hospital measures-Abdominal hysterectomy (ordinality: 'Principal')" during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator Exclusions 6 =
- AND:
  - OR:
    - AND: "Occurrence A of Diagnosis, Active: Any Infection Prior to Anesthesia Concepts" starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
    - AND NOT: "Occurrence A of Diagnosis, Active: Any Infection Prior to Anesthesia Concepts" ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Occurrence A of Patient Characteristic Clinical Trial Participant: Clinical Trial Participant" starts before or during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Occurrence A of Patient Characteristic Clinical Trial Participant: Clinical Trial Participant" ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - AND: "Patient Characteristic Expired: Expired" starts after start of "Occurrence A of Procedure, Performed: Hospital measures-Abdominal hysterectomy (incision datetime)"
    - AND NOT: "Patient Characteristic Expired: Expired" >= 6 hour(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Medication, Administered: IM or PO Antimicrobial medications (route: 'IM or PO route')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Medication, Administered: IV Antimicrobial medication (route: 'Hospital measures-Route IV')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - AND: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" > 1440 minute(s) starts before start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
    - AND:
      - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)"
      - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" starts after start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
  - OR:
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)"
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" starts after start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
  - OR:
    - AND: "Medication, Active: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 24 hour(s) starts before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR: "Procedure, Performed: Hospital measures-Pacemaker or implantable defibrillator insertion procedure" <= 3 day(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Procedure, Performed: Hospital measures-Pacemaker or implantable defibrillator insertion procedure" <= 3 day(s) ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence B of Procedure, Performed: General or Neuraxial Anesthesia" <= 3 day(s) ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence B of Procedure, Performed: General or Neuraxial Anesthesia" <= 3 day(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence A of Diagnosis, Active: Hospital Measures - Any infection (ordinality: 'Principal')" during "Encounter, Performed: Encounter Inpatient"
Numerator 6 =
- AND:
  - OR:
    - AND: "Medication, Allergy: Hospital Measures-Beta lactams for allergy determination" starts before start of "Occurrence A of Procedure, Performed: Hospital measures-Abdominal hysterectomy"
    - AND:
      - OR:
        
        AND: "Medication, Administered: Hospital Measures-IV Clindamycin (route: 'Hospital measures-Route IV')"
        
        AND: "Medication, Administered: Hospital Measures-IV Aminoglycosides (route: 'Hospital measures-Route IV')"
        
        <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
      - OR:
        
        AND: "Medication, Administered: Hospital Measures-IV Clindamycin (route: 'Hospital measures-Route IV')"
        
        AND: "Medication, Administered: Hospital Measures-IV Hysterectomy and Colon Quinolones (route: 'Hospital measures-Route IV')"
        
        <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
      - OR:
        
        AND: "Medication, Administered: Hospital Measures-IV Clindamycin (route: 'Hospital measures-Route IV')"
        
        AND: "Medication, Administered: Hospital Measures-IV Aztreonam (route: 'Hospital measures-Route IV')"
        
        <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
      - OR:
        
        AND: "Medication, Administered: Hospital Measures-IV Metronidazole (route: 'Hospital measures-Route IV')"
        
        AND: "Medication, Administered: Hospital Measures-IV Aminoglycosides (route: 'Hospital measures-Route IV')"
        
        <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
      - OR:
        
        AND: "Medication, Administered: Hospital Measures-IV Metronidazole (route: 'Hospital measures-Route IV')"
        
        AND: "Medication, Administered: Hospital Measures-IV Hysterectomy and Colon Quinolones (route: 'Hospital measures-Route IV')"
        
        <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
      - OR:
        
        AND: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')"
        
        AND: "Medication, Administered: Hospital Measures-IV Aminoglycosides (route: 'Hospital measures-Route IV')"
        
        <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
      - OR:
        
        AND: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')"
        
        AND: "Medication, Administered: Hospital Measures-IV Aztreonam (route: 'Hospital measures-Route IV')"
        
        <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
      - OR:
        
        AND: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')"
        
        AND: "Medication, Administered: Hospital Measures-IV Hysterectomy and Colon Quinolones (route: 'Hospital measures-Route IV')"
        
        <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Medication, Administered: Antibiotics for Prophylaxis for Hysterectomy Surgeries (route: 'Hospital measures-Route IV')" <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Occurrence A of Procedure, Performed: Hospital measures- Colon surgery" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND: "Medication, Administered: Hospital Measures-IV Ertapenem (route: 'Hospital measures-Route IV')" <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator Exceptions 6=
- None

------ Population Criteria 7 ------

Initial Patient Population 7 =
- AND: "Patient Characteristic Birthdate: birth date" >= 18 year(s) starts before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
- AND: "Occurrence A of Encounter, Performed: Encounter Inpatient (length of stay <= 120 day(s))"
- AND: "Occurrence A of Encounter, Performed: Encounter Inpatient" ends during "Measurement Period"
- AND: "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
- AND: "Occurrence A of Procedure, Performed: SCIP Major Surgical Procedure (ordinality: 'Principal')" during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator 7 =
- AND: "Initial Patient Population 7"
- AND: "Occurrence A of Procedure, Performed: Hospital measures-Vaginal hysterectomy (ordinality: 'Principal')" during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator Exclusions 7 =
- AND:
  - OR:
    - AND: "Occurrence A of Diagnosis, Active: Any Infection Prior to Anesthesia Concepts" starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
    - AND NOT: "Occurrence A of Diagnosis, Active: Any Infection Prior to Anesthesia Concepts" ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Occurrence A of Patient Characteristic Clinical Trial Participant: Clinical Trial Participant" starts before or during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Occurrence A of Patient Characteristic Clinical Trial Participant: Clinical Trial Participant" ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - AND: "Patient Characteristic Expired: Expired" starts after start of "Occurrence A of Procedure, Performed: Hospital measures-Vaginal hysterectomy (incision datetime)"
    - AND NOT: "Patient Characteristic Expired: Expired" >= 6 hour(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Medication, Administered: IM or PO Antimicrobial medications (route: 'IM or PO route')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Medication, Administered: IV Antimicrobial medication (route: 'Hospital measures-Route IV')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - AND: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" > 1440 minute(s) starts before start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
    - AND:
      - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)"
      - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" starts after start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
  - OR:
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)"
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" starts after start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
  - OR:
    - AND: "Medication, Active: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 24 hour(s) starts before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR: "Procedure, Performed: Hospital measures-Pacemaker or implantable defibrillator insertion procedure" <= 3 day(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Procedure, Performed: Hospital measures-Pacemaker or implantable defibrillator insertion procedure" <= 3 day(s) ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence B of Procedure, Performed: General or Neuraxial Anesthesia" <= 3 day(s) ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence B of Procedure, Performed: General or Neuraxial Anesthesia" <= 3 day(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence A of Diagnosis, Active: Hospital Measures - Any infection (ordinality: 'Principal')" during "Encounter, Performed: Encounter Inpatient"
Numerator 7 =
- AND:
  - OR:
    - AND: "Medication, Allergy: Hospital Measures-Beta lactams for allergy determination" starts before start of "Occurrence A of Procedure, Performed: Hospital measures-Vaginal hysterectomy"
    - AND:
      - OR:
        
        AND: "Medication, Administered: Hospital Measures-IV Clindamycin (route: 'Hospital measures-Route IV')"
        
        AND: "Medication, Administered: Hospital Measures-IV Aminoglycosides (route: 'Hospital measures-Route IV')"
        
        <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
      - OR:
        
        AND: "Medication, Administered: Hospital Measures-IV Clindamycin (route: 'Hospital measures-Route IV')"
        
        AND: "Medication, Administered: Hospital Measures-IV Hysterectomy and Colon Quinolones (route: 'Hospital measures-Route IV')"
        
        <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
      - OR:
        
        AND: "Medication, Administered: Hospital Measures-IV Clindamycin (route: 'Hospital measures-Route IV')"
        
        AND: "Medication, Administered: Hospital Measures-IV Aztreonam (route: 'Hospital measures-Route IV')"
        
        <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
      - OR:
        
        AND: "Medication, Administered: Hospital Measures-IV Metronidazole (route: 'Hospital measures-Route IV')"
        
        AND: "Medication, Administered: Hospital Measures-IV Aminoglycosides (route: 'Hospital measures-Route IV')"
        
        <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
      - OR:
        
        AND: "Medication, Administered: Hospital Measures-IV Metronidazole (route: 'Hospital measures-Route IV')"
        
        AND: "Medication, Administered: Hospital Measures-IV Hysterectomy and Colon Quinolones (route: 'Hospital measures-Route IV')"
        
        <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
      - OR:
        
        AND: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')"
        
        AND: "Medication, Administered: Hospital Measures-IV Aminoglycosides (route: 'Hospital measures-Route IV')"
        
        <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
      - OR:
        
        AND: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')"
        
        AND: "Medication, Administered: Hospital Measures-IV Aztreonam (route: 'Hospital measures-Route IV')"
        
        <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
      - OR:
        
        AND: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')"
        
        AND: "Medication, Administered: Hospital Measures-IV Hysterectomy and Colon Quinolones (route: 'Hospital measures-Route IV')"
        
        <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Medication, Administered: Antibiotics for Prophylaxis for Hysterectomy Surgeries (route: 'Hospital measures-Route IV')" <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Occurrence A of Procedure, Performed: Hospital measures- Colon surgery" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND: "Medication, Administered: Hospital Measures-IV Ertapenem (route: 'Hospital measures-Route IV')" <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator Exceptions 7=
- None

------ Population Criteria 8 ------

Initial Patient Population 8 =
- AND: "Patient Characteristic Birthdate: birth date" >= 18 year(s) starts before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
- AND: "Occurrence A of Encounter, Performed: Encounter Inpatient (length of stay <= 120 day(s))"
- AND: "Occurrence A of Encounter, Performed: Encounter Inpatient" ends during "Measurement Period"
- AND: "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
- AND: "Occurrence A of Procedure, Performed: SCIP Major Surgical Procedure (ordinality: 'Principal')" during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator 8 =
- AND: "Initial Patient Population 8"
- AND: "Occurrence A of Procedure, Performed: Hospital measures-Vascular surgery (ordinality: 'Principal')" during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator Exclusions 8 =
- AND:
  - OR:
    - AND: "Occurrence A of Diagnosis, Active: Any Infection Prior to Anesthesia Concepts" starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
    - AND NOT: "Occurrence A of Diagnosis, Active: Any Infection Prior to Anesthesia Concepts" ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Occurrence A of Patient Characteristic Clinical Trial Participant: Clinical Trial Participant" starts before or during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Occurrence A of Patient Characteristic Clinical Trial Participant: Clinical Trial Participant" ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - AND: "Patient Characteristic Expired: Expired" starts after start of "Occurrence A of Procedure, Performed: Hospital measures-Vascular surgery (incision datetime)"
    - AND NOT: "Patient Characteristic Expired: Expired" >= 6 hour(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Medication, Administered: IM or PO Antimicrobial medications (route: 'IM or PO route')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Medication, Administered: IV Antimicrobial medication (route: 'Hospital measures-Route IV')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - AND: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" > 1440 minute(s) starts before start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
    - AND:
      - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)"
      - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" starts after start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
  - OR:
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)"
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" starts after start of ("Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia (incision datetime)" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
  - OR:
    - AND: "Medication, Active: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" <= 24 hour(s) starts before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR: "Procedure, Performed: Hospital measures-Pacemaker or implantable defibrillator insertion procedure" <= 3 day(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Procedure, Performed: Hospital measures-Pacemaker or implantable defibrillator insertion procedure" <= 3 day(s) ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence B of Procedure, Performed: General or Neuraxial Anesthesia" <= 3 day(s) ends before start of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence B of Procedure, Performed: General or Neuraxial Anesthesia" <= 3 day(s) starts after end of "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR: "Occurrence A of Diagnosis, Active: Hospital Measures - Any infection (ordinality: 'Principal')" during "Encounter, Performed: Encounter Inpatient"
Numerator 8 =
- AND:
  - OR:
    - AND: "Medication, Allergy: Hospital Measures-Beta lactams for allergy determination" starts before start of "Occurrence A of Procedure, Performed: Hospital measures-Vascular surgery"
    - AND:
      - OR: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')"
      - OR: "Medication, Administered: Hospital Measures-IV Clindamycin (route: 'Hospital measures-Route IV')"
      - <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
  - OR:
    - AND: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')" <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
    - AND:
      - OR: "Encounter, Performed: Encounter Inpatient (discharge datetime)" <= 1 year(s) ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
      - OR: "Procedure, Performed: Hospital measures-Hemodialysis or peritoneal dialysis" <= 1 year(s) starts before start of "Occurrence A of Procedure, Performed: Hospital measures-Vascular surgery (incision datetime)"
      - OR: "Occurrence A of Encounter, Performed: Encounter Inpatient (admission datetime)" > 1440 minute(s) starts before start of "Occurrence A of Procedure, Performed: Hospital measures-Vascular surgery (incision datetime)"
      - OR:
        
        AND: "Occurrence A of Diagnosis, Active: Hospital Measures-MRSA Colonization or Infection" starts before start of "Occurrence A of Procedure, Performed: Hospital measures-Vascular surgery (incision datetime)"
        
        AND NOT: "Occurrence A of Diagnosis, Active: Hospital Measures-MRSA Colonization or Infection" ends before start of "Occurrence A of Procedure, Performed: Hospital measures-Vascular surgery (incision datetime)"
      - OR:
        
        AND: "Occurrence A of Intervention, Performed: Hospital Measures-Chronic Wound Care" starts before start of "Occurrence A of Procedure, Performed: Hospital measures-Vascular surgery (incision datetime)"
        
        AND NOT: "Occurrence A of Intervention, Performed: Hospital Measures-Chronic Wound Care" ends before start of "Occurrence A of Procedure, Performed: Hospital measures-Vascular surgery (incision datetime)"
      - OR:
        
        AND: "Occurrence A of Procedure, Performed: Hospital Measures-Cardiac Valve Surgery" starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
        
        AND: "Occurrence A of Procedure, Performed: Hospital Measures-Cardiac Valve Surgery" during "Occurrence A of Encounter, Performed: Encounter Inpatient"
      - OR:
        
        AND: "Transfer From: Hospital Measures-Acute care hospital"
        
        AND: "Encounter, Performed: Hospital measures-Acute care hospital encounter (length of stay >= 3 day(s))"
        
        < 24 hour(s) ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - OR: "Medication, Administered: Cefuroxime and Cefazolin Antibiotics for IV Administration (route: 'Hospital measures-Route IV')"
    - OR:
      - AND: "Medication, Order: Hospital measures-IV Vancomycin (reason: 'Hospital measures - Request of physician')"
      - AND: "Medication, Administered: Hospital measures-IV Vancomycin (route: 'Hospital measures-Route IV')"
    - <= 1440 minute(s) starts before or during "Occurrence A of Procedure, Performed: General or Neuraxial Anesthesia"
Denominator Exceptions 8=
- None

eMeasure Title	Prophylactic Antibiotic Selection for Surgical Patients
eMeasure Identifier (Measure Authoring Tool)	172	eMeasure Version number	4
NQF Number	0528	GUID	feea3922-f61f-4b05-98f9-b72a11815f12
Measurement Period	January 1, 20xx through December 31, 20xx
Measure Steward	Centers for Medicare & Medicaid Services
Measure Developer	Oklahoma Foundation for Medical Quality
Endorsed By	National Quality Forum
Description	Surgical patients who received prophylactic antibiotics consistent with current guidelines (specific to each type of surgical procedure).
Copyright	Measure specifications are in the Public Domain LOINC(R) is a registered trademark of the Regenstrief Institute. This material contains SNOMED Clinical Terms (R) (SNOMED CT(c)) copyright 2004-2010 International Health Terminology Standards Development Organization. All rights reserved.
Disclaimer	None
Measure Scoring	Proportion
Measure Type	Process
Stratification	None
Risk Adjustment	None
Rate Aggregation	None
Rationale	A goal of prophylaxis with antibiotics is to use an agent that is safe, cost-effective, and has a spectrum of action that covers most of the probable intraoperative contaminants for the operation. First or second-generation cephalosporins satisfy these criteria for most operations, although anaerobic coverage is needed for colon surgery. Vancomycin is not recommended for routine use because of the potential for development of antibiotic resistance, but is acceptable if a patient is allergic to beta-lactams, as are fluoroquinolones and clindamycin in selected situations.
Clinical Recommendation Statement	National guidelines recommend specific classes of antibiotics for surgical procedures. First or second-generation cephalosporins satisfy the criteria (safe, cost-effective, and coverage for most probable contaminants) for most operations, although anaerobic coverage is needed for colon surgery.
Improvement Notation	Higher score indicates better quality.
Reference	Bratzler DW, Houck PM, for the Surgical Infection Prevention Guidelines Writers Group. Antimicrobial prophylaxis for surgery: An advisory statement from the National Surgical Infection Prevention Project. CID. 2004:38(15 June):1706-1715.
Reference	Mangram AJ, Horan TC, Pearson ML, et al. Guidelines for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999;20:247-280.
Reference	American Society of Health-System Pharmacists. ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 1999;56:1839-1888.
Reference	No author listed. The Medical letter. Antimicrobial prophylaxis for Surgery. Med Lett Drugs Ther. 2009; 82: 47-52.
Reference	Dellinger EP, Gross PA, Barrett TL, et al. Quality standard for antimicrobial prophylaxis in surgical procedures. Clin Infect Dis. 1994;18:422-427.
Reference	Gilbert DN, Moellering RC Jr., Elipoulos GM, Chamber HF, Saag MS, eds. The Sanford Guide to Antimicrobial Therapy 2009. 39st ed. Sperryville, VA: Antimicrobial Therapy, Inc; 2009.
Reference	Itani KMF, Wilson SE, Awad SS, Jensen EH, Finn TS, Abramson MA. Ertapenem versus cefotetan prophylaxis in elective colorectal surgery. N Engl J Med. 2006 Dec 21; 355 (25): 2640-2651.
Reference	Page CP, Bohnen JM, Fletcher JR, et al. Antimicrobial prophylaxis for surgical wounds. Arch Surg. 1993;128:79-88.
Reference	American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins ACOG Practice Bulletin No 104 Antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol May 2009; 113(5) : 1180-1189.
Reference	Bratzler DW, Houck PM, for the Surgical Infection Prevention Guidelines Writers Group. Antimicrobial prophylaxis for surgery: An advisory statement from the National Surgical Infection Prevention Project. CID. 2004:38(15 June):1706-1715.
Definition	None
Guidance	The measurement period is one calendar year but the reporting period is 3 months as a calendar quarter; Q1 = Jan – Mar, Q2 = Apr – Jun, Q3 = Jul – Sep, Q4 is Oct – Dec. Denominator Exclusion guidance: The exclusion for patients who are clinical trial participants is limited to patients participating in a clinical trial for the same conditions as covered by the measure. Other clinical trials are not valid reasons for exclusions. Numerator element guidance: Vancomycin is acceptable for CABG, other cardiac procedures, hip arthroplasty, knee arthroplasty and vascular surgery if there is an increased MRSA rate facility-wide or operation-specific. For the purpose of using vancomycin for prophylaxis, it is expected that vancomycin is given ONLY if one of the allowable conditions is TRUE.
Transmission Format	None
Initial Patient Population	All hospital discharges for selective surgery with hospital stays <= 120 days during the measurement year for patients age 18 and older at the time of hospital admission with no evidence of prior infection. The measure is divided into 8 populations by type of surgery. Each denominator provides criteria for the types of surgery.
Denominator	All selected surgical patients 18 years of age and older with no evidence of prior infection with a Principal Procedure Code of selected surgeries. Denominator for population 1 - Coronary artery bypass graft (CABG) procedures Denominator for population 2 - Other cardiac surgery Denominator for population 3 - Hip arthroplasty Denominator for population 4 - Knee arthroplasty Denominator for population 5 - Colon surgery Denominator for population 6 - Abdominal hysterectomy Denominator for population 7 - Vaginal hysterectomy Denominator for population 8 - Vascular surgery
Denominator Exclusions	• Patients who had a principal diagnosis suggestive of preoperative infectious diseases • Patients enrolled in clinical trials-this exclusion is limited to patients participating in a clinical trial for the same conditions as covered by the measure. Other clinical trials are not valid reasons for exclusion. • Patients whose principal procedure occurred prior to the date of admission • Patients with physician/advanced practice nurse/physician assistant (physician/APN/PA) documented infection prior to surgical procedure of interest • Patients who expired perioperatively • Patients who had other procedures requiring general or spinal anesthesia that occurred within 3 days (4 days for CABG or Other Cardiac Surgery) prior to or after the procedure of interest (during separate surgical episodes) during this hospital stay • Patients who did not receive any antibiotics within the timeframe 24 hours before Surgical Incision Date and Time (i.e., patient did not receive prophylactic antibiotics) through discharge • Patients who received antibiotics prior to arrival and did not receive any antibiotics during this hospitalization • Patients who received ONLY oral or intramuscular (IM) antibiotics or the route was unable to be determined • Patients who received ALL antibiotics greater than 1440 minutes prior to Surgical Incision Date and Time
Numerator	Number of surgical patients who received prophylactic antibiotics recommended for their specific surgical procedure.
Numerator Exclusions	Not applicable
Denominator Exceptions	None
Measure Population	Not applicable.
Measure Observations	Not applicable.
Supplemental Data Elements	For every patient evaluated by this measure also identify payer, race, ethnicity, and sex.

Table of Contents

Population criteria

Data criteria (QDM Data Elements)

Reporting Stratification

Supplemental Data Elements