Hospital Harm - Postoperative Respiratory Failure 0.0.141

This electronic clinical quality measure (eCQM) assesses the proportion 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, disclaims all liability for use or accuracy of any third party codes contained in the specifications.

LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 copyright 2022 World Health Organization. All Rights Reserved.

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

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].

Report the first resulted vital sign values during the encounter in 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, d/L
 - Aspartate aminotransferase (AST/SGOT): U/L, IU/L
 - Bicarbonate: meq/L, 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
 - 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
 - Body mass index (BMI)
 - Encounter diagnoses with their present on admission (POA) indicators
 - Smoking status
 - Surgical Procedures

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, et al., 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, et al., 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.

Decreased score indicates improvement

Reference Type: CITATION

Reference Text: 'Arozullah AM, Daley J, Henderson WG, Khuri SF. (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'

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'

Reference Type: CITATION

Reference Text: 'Canet J, Sabaté S, Mazo V, et al. (2015). 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):458-470'

Reference Type: CITATION

Reference Text: 'Gupta H, Gupta PK, Fang X, et al. (2011). Development and validation of a risk calculator predicting postoperative respiratory failure. Chest.140(5):1207-1215'

Reference Type: CITATION

Reference Text: 'Kor DJ, Lingineni RK, Gajic O, et al. (2014). Predicting risk of postoperative lung injury in high-risk surgical patients: a multicenter cohort study. Anesthesiology. 120(5):1168-1181'

Reference Type: CITATION

Reference Text: 'Miller MR, Elixhauser A, Zhan C, Meyer GS. (2001). Patient Safety Indicators: using administrative data to identify potential patient safety concerns. Health services research. 36(6 Pt 2):110-132'

Reference Type: CITATION

Reference Text: 'Rahman M, Neal D, Fargen KM, Hoh BL. Establishing standard performance measures for adult brain tumor patients: a Nationwide Inpatient Sample database study. Neuro Oncol. 2013;15(11):1580-1588'

Reference Type: CITATION

Reference Text: 'Romano PS, Mull HJ, Rivard PE, et al. (2009). Validity of Selected AHRQ Patient Safety Indicators Based on VA National Surgical Quality Improvement Program Data. Health Services Research. 44(1):182-204'

Reference Type: CITATION

Reference Text: 'Thompson SL, Lisco SJ. Postoperative Respiratory Failure. Int Anesthesiol Clin. 2018;56(1):147-164'

"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 and is modeled by the use of general or neuraxial anesthesia during the encounter. These combined concepts determine a qualifying elective surgical procedure occurred. 

“General and Neuraxial Anesthesia” value set intends to capture an occurrence of a procedure or surgery.

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.

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

Procedural areas include operating rooms, endoscopy, cardiac catheterization and interventional radiology suites.

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 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 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:

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

With any diagnosis for neuromuscular disorder or degenerative neurological disorder 

With any procedure for selected pharyngeal, nasal, oral, facial, or tracheal surgery involving significant risk of airway compromise likely to require prophylactic  retention of the endotracheal tube for at least 48 hours

Elective inpatient hospitalizations for patients with postoperative respiratory failure (PRF) as evidenced by: 

Criterion A: Mechanical Ventilation (MV) initiated within 30 days after First operating room (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 and without Obstetrical Condition"

- Denominator
  - "Initial Population"

Denominator Exclusions

"Encounter with Mechanical Ventilation that Starts More than One Hour 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 PaCO2 Greater Than 50 and Arterial pH Less Than 7.30 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"
  union "Encounter with Neuromuscular Disorder"
  union "Encounter with Degenerative Neurological Disorder"
  union "Encounter with High Risk to Airway Head and Neck Surgery"

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

Denominator
- - "Initial Population"

Denominator Exclusions

"Encounter with Mechanical Ventilation that Starts More than One Hour 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 PaCO2 Greater Than 50 and Arterial pH Less Than 7.30 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"
  union "Encounter with Neuromuscular Disorder"
  union "Encounter with Degenerative Neurological Disorder"
  union "Encounter with High Risk to Airway Head and Neck Surgery"

Elective Inpatient Encounter with Age 18 and Older

"Elective Inpatient Encounter with OR Procedure During Measurement Period" ElectiveEncounterPeriod
  where AgeInYearsAt(date from start of ElectiveEncounterPeriod.relevantPeriod)>= 18

Elective Inpatient Encounter with Age 18 and Older with OR Procedure within 3 Days

"Elective Inpatient Encounter with Age 18 and Older" ElectiveInpatientEncounter
  with "Procedure with Anesthesia" SurgeryWithAnesthesia
    such that Global."NormalizeInterval" ( SurgeryWithAnesthesia.relevantDatetime, SurgeryWithAnesthesia.relevantPeriod ) starts 3 days or less after start of "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(ElectiveInpatientEncounter)

Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition

"Elective Inpatient Encounter with Age 18 and Older with OR Procedure within 3 Days" EncounterWithSurgery
  where not exists EncounterWithSurgery.diagnoses EncounterDiagnoses
    where EncounterDiagnoses.code in "Obstetrics and VTE Obstetrics"

Elective Inpatient Encounter with OR Procedure During Measurement Period

["Encounter, Performed": "Elective Inpatient Encounter"] ElectiveEncounter
  with ["Procedure, Performed": "General and Neuraxial Anesthesia"] SurgeryWithAnesthesia
    such that Global."NormalizeInterval" ( SurgeryWithAnesthesia.relevantDatetime, SurgeryWithAnesthesia.relevantPeriod ) ends during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(ElectiveEncounter)
      and ElectiveEncounter.relevantPeriod ends during day of "Measurement Period"
      and ElectiveEncounter.class ~ "Elective (qualifier value)"

Encounter with Degenerative Neurological Disorder

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" EncounterWithSurgery
  where exists ( EncounterWithSurgery.diagnoses EncounterDiagnosis
      where EncounterDiagnosis.code in "Degenerative Neurological Disorder"
  )

Encounter with Extubation Outside of Procedural Area More Than 48 Hours After End of OR Procedure and not Preceded by Non Invasive Oxygen Therapy or Anesthesia

from
  "Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" EncounterWithSurgery,
  ["Procedure, Performed": "Removal of endotracheal tube (procedure)"] AirwayTubeOut,
  ["Procedure, Performed": "General and Neuraxial Anesthesia"] ProcedureWithAnesthesia1
  where Global."NormalizeInterval" ( AirwayTubeOut.relevantDatetime, AirwayTubeOut.relevantPeriod ) starts more than 48 hours after 
  end of Global."NormalizeInterval" ( ProcedureWithAnesthesia1.relevantDatetime, ProcedureWithAnesthesia1.relevantPeriod )
    and Global."NormalizeInterval" ( AirwayTubeOut.relevantDatetime, AirwayTubeOut.relevantPeriod ) starts 30 days or less after 
    end of Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod )
    and Global."NormalizeInterval" ( AirwayTubeOut.relevantDatetime, AirwayTubeOut.relevantPeriod ) starts during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)
    and Global."NormalizeInterval" ( ProcedureWithAnesthesia1.relevantDatetime, ProcedureWithAnesthesia1.relevantPeriod ) starts during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)
    and not exists ( EncounterWithSurgery.facilityLocations EncounterLocation
        where EncounterLocation.code in "Procedural Hospital Locations"
          and Global."NormalizeInterval" ( AirwayTubeOut.relevantDatetime, AirwayTubeOut.relevantPeriod ) starts during EncounterLocation.locationPeriod
    )
    and not exists ( "Noninvasive Oxygen Therapy" OxygenSupport
        where Global."NormalizeInterval" ( OxygenSupport.relevantDatetime, OxygenSupport.relevantPeriod ) starts during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)
          and Global."NormalizeInterval" ( OxygenSupport.relevantDatetime, OxygenSupport.relevantPeriod ) starts during Interval[
          end of Global."NormalizeInterval" ( ProcedureWithAnesthesia1.relevantDatetime, ProcedureWithAnesthesia1.relevantPeriod ), start of Global."NormalizeInterval" ( AirwayTubeOut.relevantDatetime, AirwayTubeOut.relevantPeriod )]
    )
    and not exists ( ["Procedure, Performed": "General and Neuraxial Anesthesia"] ProcedureWithAnesthesia2
        where Global."NormalizeInterval" ( ProcedureWithAnesthesia2.relevantDatetime, ProcedureWithAnesthesia2.relevantPeriod ) starts during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)
          and Global."NormalizeInterval" ( ProcedureWithAnesthesia2.relevantDatetime, ProcedureWithAnesthesia2.relevantPeriod ) starts during Interval[
          end of Global."NormalizeInterval" ( ProcedureWithAnesthesia1.relevantDatetime, ProcedureWithAnesthesia1.relevantPeriod ), start of Global."NormalizeInterval" ( AirwayTubeOut.relevantDatetime, AirwayTubeOut.relevantPeriod )]
          and ProcedureWithAnesthesia1.id != ProcedureWithAnesthesia2.id
    )
  return EncounterWithSurgery

Encounter with High Risk to Airway Head and Neck Surgery

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" EncounterWithSurgery
  with ["Procedure, Performed": "Head and Neck Surgeries with High Risk Airway Compromise"] HeadNeckProcedures
    such that Global."NormalizeInterval" ( HeadNeckProcedures.relevantDatetime, HeadNeckProcedures.relevantPeriod ) starts during "AIR.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 and without Obstetrical Condition" EncounterWithSurgery,
  ["Procedure, Performed": "Intubation"] EndotrachealTubeIn
  let EndotrachTubeInTime: Global."NormalizeInterval" ( EndotrachealTubeIn.relevantDatetime, EndotrachealTubeIn.relevantPeriod ),
  FirstProcedureTime: Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod ),
  HospitalizationPeriod: "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)
  with ["Procedure, Performed": "Intubation"] EndotrachealTubeIn
    such that EndotrachTubeInTime starts during HospitalizationPeriod
      and EndotrachTubeInTime starts 30 days or less after 
      end of FirstProcedureTime
      and not exists ( EncounterWithSurgery.facilityLocations EncounterLocation
          where EncounterLocation.code in "Procedural Hospital Locations"
            and EndotrachTubeInTime starts during EncounterLocation.locationPeriod
      )
  return EncounterWithSurgery

Encounter with Mechanical Ventilation 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 and without Obstetrical Condition" EncounterWithSurgery,
  ["Procedure, Performed": "Mechanical Ventilation"] Ventilation,
  ["Procedure, Performed": "General and Neuraxial Anesthesia"] ProcedureWithAnesthesia1
  where Global."NormalizeInterval" ( Ventilation.relevantDatetime, Ventilation.relevantPeriod ) starts more than 48 hours after 
  end of Global."NormalizeInterval" ( ProcedureWithAnesthesia1.relevantDatetime, ProcedureWithAnesthesia1.relevantPeriod )
    and Global."NormalizeInterval" ( Ventilation.relevantDatetime, Ventilation.relevantPeriod ) starts less than 72 hours after 
    end of Global."NormalizeInterval" ( ProcedureWithAnesthesia1.relevantDatetime, ProcedureWithAnesthesia1.relevantPeriod )
    and Global."NormalizeInterval" ( Ventilation.relevantDatetime, Ventilation.relevantPeriod ) starts 30 days or less after start of Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod )
    and Global."NormalizeInterval" ( Ventilation.relevantDatetime, Ventilation.relevantPeriod ) starts during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)
    and Global."NormalizeInterval" ( ProcedureWithAnesthesia1.relevantDatetime, ProcedureWithAnesthesia1.relevantPeriod ) starts during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)
    and not exists ( ( ["Procedure, Performed": "Non Invasive Oxygen Therapy by Nasal Cannula or Mask"] OxygenSupport
          where Global."NormalizeInterval" ( OxygenSupport.relevantDatetime, OxygenSupport.relevantPeriod ) starts during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)
            and Global."NormalizeInterval" ( OxygenSupport.relevantDatetime, OxygenSupport.relevantPeriod ) starts during Interval[
            end of Global."NormalizeInterval" ( ProcedureWithAnesthesia1.relevantDatetime, ProcedureWithAnesthesia1.relevantPeriod ), 
            end of Global."NormalizeInterval" ( Ventilation.relevantDatetime, Ventilation.relevantPeriod )]
      )
        union ( ["Assessment, Performed": "Non Invasive Oxygen Therapy"] OxygenTherapy
            where Global."NormalizeInterval" ( OxygenTherapy.relevantDatetime, OxygenTherapy.relevantPeriod ) starts during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)
              and Global."NormalizeInterval" ( OxygenTherapy.relevantDatetime, OxygenTherapy.relevantPeriod ) starts during Interval[
              end of Global."NormalizeInterval" ( ProcedureWithAnesthesia1.relevantDatetime, ProcedureWithAnesthesia1.relevantPeriod ), 
              end of Global."NormalizeInterval" ( Ventilation.relevantDatetime, Ventilation.relevantPeriod )]
        )
    )
    and not exists ( ["Procedure, Performed": "General and Neuraxial Anesthesia"] ProcedureWithAnesthesia2
        where Global."NormalizeInterval" ( ProcedureWithAnesthesia2.relevantDatetime, ProcedureWithAnesthesia2.relevantPeriod ) starts during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)
          and Global."NormalizeInterval" ( ProcedureWithAnesthesia2.relevantDatetime, ProcedureWithAnesthesia2.relevantPeriod ) starts during Interval[
          end of Global."NormalizeInterval" ( ProcedureWithAnesthesia1.relevantDatetime, ProcedureWithAnesthesia1.relevantPeriod ), 
          end of Global."NormalizeInterval" ( Ventilation.relevantDatetime, Ventilation.relevantPeriod )]
          and ProcedureWithAnesthesia1.id != ProcedureWithAnesthesia2.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 or Anesthesia

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" EncounterWithSurgery
  with ["Procedure, Performed": "Mechanical Ventilation"] Ventilation
    such that Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod ) starts during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)
      and Global."NormalizeInterval" ( Ventilation.relevantDatetime, Ventilation.relevantPeriod ) starts during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)
      and Global."NormalizeInterval" ( Ventilation.relevantDatetime, Ventilation.relevantPeriod ) starts 30 days or less after 
      end of Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod )
      and not exists ( EncounterWithSurgery.facilityLocations EncounterLocation
          where EncounterLocation.code in "Procedural Hospital Locations"
            and Global."NormalizeInterval" ( Ventilation.relevantDatetime, Ventilation.relevantPeriod ) starts during EncounterLocation.locationPeriod
      )
      and exists ( "Noninvasive Oxygen Therapy" OxygenSupport
          where Global."NormalizeInterval" ( OxygenSupport.relevantDatetime, OxygenSupport.relevantPeriod ) starts during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)
            and Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod ) starts during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)
            and Global."NormalizeInterval" ( OxygenSupport.relevantDatetime, OxygenSupport.relevantPeriod ) starts during Interval[
            end of Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod ), start of Global."NormalizeInterval" ( Ventilation.relevantDatetime, Ventilation.relevantPeriod )]
      )
      and not exists ( ["Procedure, Performed": "General and Neuraxial Anesthesia"] ProcedureWithAnesthesia
          where Global."NormalizeInterval" ( ProcedureWithAnesthesia.relevantDatetime, ProcedureWithAnesthesia.relevantPeriod ) starts during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)
            and Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod ) starts during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)
            and Global."NormalizeInterval" ( ProcedureWithAnesthesia.relevantDatetime, ProcedureWithAnesthesia.relevantPeriod ) starts during Interval[
            end of Global."NormalizeInterval" ( "FirstProcedure"(EncounterWithSurgery).relevantDatetime, "FirstProcedure"(EncounterWithSurgery).relevantPeriod ), start of Global."NormalizeInterval" ( Ventilation.relevantDatetime, Ventilation.relevantPeriod )]
            and "FirstProcedure"(EncounterWithSurgery).id != ProcedureWithAnesthesia.id
      )

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

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" 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 "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)

Encounter with Neuromuscular Disorder

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" 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 and without Obstetrical Condition" EncounterWithSurgery,
  ["Laboratory Test, Performed": "Carbon dioxide [Partial pressure] in Arterial blood"] CarbonDioxide,
  ["Laboratory Test, Performed": "pH of Arterial blood"] 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 "AIR.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 and without Obstetrical Condition" 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 "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)
  return EncounterWithSurgery

Encounter with Principal Diagnosis of Acute Respiratory Failure

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" 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

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" EncounterWithSurgery
  where exists ( EncounterWithSurgery.diagnoses Diagnosis
      where Diagnosis.code in "Acute Respiratory Failure"
        and Diagnosis.rank >= 2
  )

Encounter with Secondary Diagnosis of Acute Respiratory Failure Present on Admission

"Encounter with Secondary Diagnosis of Acute Respiratory Failure" RespiratoryFailureEncounter
  where exists ( RespiratoryFailureEncounter.diagnoses Dx
      where Dx.code in "Acute Respiratory Failure"
        and Dx.presentOnAdmissionIndicator in "Present on Admission or Clinically Undetermined"
  )

Encounter with Tracheostomy Before Day of First OR Procedure

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" EncounterWithSurgery
  with ["Procedure, Performed": "Tracheostomy Procedures"] TracheostomySurgery
    such that Global."NormalizeInterval" ( TracheostomySurgery.relevantDatetime, TracheostomySurgery.relevantPeriod ) starts during "AIR.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 "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)

Encounter with Tracheostomy Present on Admission

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" 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 and without Obstetrical Condition" EncounterWithSurgery
  with ["Procedure, Performed": "Tracheostomy Procedures"] TracheostomySurgery
    such that Global."NormalizeInterval" ( TracheostomySurgery.relevantDatetime, TracheostomySurgery.relevantPeriod ) starts during "AIR.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 "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)

Initial Population

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition"

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

Procedure with Anesthesia

["Procedure, Performed": "General and Neuraxial Anesthesia"] SurgeryWithAnesthesia

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 "AIR.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,
  "Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" EncounterWithSurgery
  where Global."NormalizeInterval" ( Procedure.relevantDatetime, Procedure.relevantPeriod ) starts during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)
  return {
    encounterId: EncounterWithSurgery.id,
    procedureId: Procedure.id,
    procedurecode: Procedure.code,
    procedurerank: Procedure.rank,
    proceduretime: Global."NormalizeInterval" ( Procedure.relevantDatetime, Procedure.relevantPeriod )
  }

Risk Variable First Albumin in Encounter

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstAlbumin: "FirstAlbumin"(QualifyingEncounter)
  }

Risk Variable First Arterial pH in Encounter

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstArterialpH: "FirstArterialpH"(QualifyingEncounter)
  }

Risk Variable First AST in Encounter

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstAST: "FirstAST"(QualifyingEncounter)
  }

Risk Variable First Bicarbonate in Encounter

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstBicarbonate: "FirstBicarbonate"(QualifyingEncounter)
  }

Risk Variable First Bilirubin in Encounter

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstBilirubin: "FirstBilirubin"(QualifyingEncounter)
  }

Risk Variable First Blood Urea Nitrogen in Encounter

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstBUN: "FirstBloodUreaNitrogen"(QualifyingEncounter)
  }

Risk Variable First BMI

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstBMI: "FirstBMI"(QualifyingEncounter)
  }

Risk Variable First Body Temperature in Encounter

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstBodyTemp: "FirstBodyTemperature"(QualifyingEncounter)
  }

Risk Variable First Carbon Dioxide in Encounter

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstCarbonDioxide: "FirstCarbonDioxide"(QualifyingEncounter)
  }

Risk Variable First Creatinine in Encounter

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstCreatinine: "FirstCreatinine"(QualifyingEncounter)
  }

Risk Variable First Heart Rate in Encounter

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstHeartRate: "FirstHeartRate"(QualifyingEncounter)
  }

Risk Variable First Hematocrit in Encounter

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstHematocrit: "FirstHematocrit"(QualifyingEncounter)
  }

Risk Variable First Hemoglobin in Encounter

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstHemoglobin: "FirstHemoglobin"(QualifyingEncounter)
  }

Risk Variable First Leukocyte Count in Encounter

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstLeukocyte: "FirstLeukocyte"(QualifyingEncounter)
  }

Risk Variable First Oxygen in Encounter

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstOxygen: "FirstOxygen"(QualifyingEncounter)
  }

Risk Variable First Platelet Count in Encounter

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstPlatelet: "FirstPlatelet"(QualifyingEncounter)
  }

Risk Variable First Respiratory Rate in Encounter

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstRespiratoryRate: "FirstRespiratoryRate"(QualifyingEncounter)
  }

Risk Variable First Sodium in Encounter

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstSodium: "FirstSodium"(QualifyingEncounter)
  }

Risk Variable First Systolic Blood Pressure in Encounter

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstSystolic: "FirstSystolicBloodPressure"(QualifyingEncounter)
  }

Risk Variable First White Blood Cell Count in Encounter

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstWBCcount: "FirstWhiteBloodCellCount"(QualifyingEncounter)
  }

Risk Variable Principle Procedure

from
  ["Procedure, Performed"] Procedure,
  "Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" EncounterWithSurgery
  where Procedure.rank = 1
    and Global."NormalizeInterval" ( Procedure.relevantDatetime, Procedure.relevantPeriod ) starts during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)
  return {
    encounterId: EncounterWithSurgery.id,
    procedureId: Procedure.id,
    procedurecode: Procedure.code,
    procedurerank: Procedure.rank,
    proceduretime: Global."NormalizeInterval" ( Procedure.relevantDatetime, Procedure.relevantPeriod )
  }

Risk Variable Smoking Status

["Assessment, Performed": "Tobacco smoking status"] SmokingStatus
  with "Initial Population" QualifyingEncounter
    such that Global."NormalizeInterval" ( SmokingStatus.relevantDatetime, SmokingStatus.relevantPeriod ) starts during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and SmokingStatus.result is not null
      and SmokingStatus.result in "Smoking status"
  return SmokingStatus.result

SDE Ethnicity

["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

["Patient Characteristic Payer": "Payer"]

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

SDE Sex

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

AIR.HospitalizationWithObservationAndOutpatientSurgeryService(Encounter "Encounter, Performed")

Encounter Visit
  let ObservationVisit: Last(["Encounter, Performed": "Observation Services"] LastObservation
      where LastObservation.relevantPeriod ends 1 hour or less on or before start of Visit.relevantPeriod
      sort by 
      end of relevantPeriod
  ),
  VisitStart: Coalesce(start of ObservationVisit.relevantPeriod, start of Visit.relevantPeriod),
  OutpatientSurgeryVisit: Last(["Encounter, Performed": "Outpatient Surgery Service"] LastSurgeryOutpatient
      where LastSurgeryOutpatient.relevantPeriod ends 1 hour or less on or before VisitStart
      sort by 
      end of relevantPeriod
  )
  return Interval[Coalesce(start of OutpatientSurgeryVisit.relevantPeriod, VisitStart), 
  end of Visit.relevantPeriod]

FirstAlbumin(QualifyingEncounter "Encounter, Performed")

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

FirstArterialpH(QualifyingEncounter "Encounter, Performed")

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

FirstAST(QualifyingEncounter "Encounter, Performed")

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

FirstBicarbonate(QualifyingEncounter "Encounter, Performed")

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

FirstBilirubin(QualifyingEncounter "Encounter, Performed")

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

FirstBloodUreaNitrogen(QualifyingEncounter "Encounter, Performed")

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

FirstBMI(QualifyingEncounter "Encounter, Performed")

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

FirstBodyTemperature(QualifyingEncounter "Encounter, Performed")

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

FirstCarbonDioxide(QualifyingEncounter "Encounter, Performed")

First(["Laboratory Test, Performed": "Carbon dioxide [Partial pressure] in Arterial blood"] FirstCarbonDioxideTest
    where Global."EarliestOf"(FirstCarbonDioxideTest.relevantDatetime, FirstCarbonDioxideTest.relevantPeriod)during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and FirstCarbonDioxideTest.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Decimal

FirstCreatinine(QualifyingEncounter "Encounter, Performed")

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

FirstHeartRate(QualifyingEncounter "Encounter, Performed")

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

FirstHematocrit(QualifyingEncounter "Encounter, Performed")

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

FirstHemoglobin(QualifyingEncounter "Encounter, Performed")

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

FirstLeukocyte(QualifyingEncounter "Encounter, Performed")

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

FirstOxygen(QualifyingEncounter "Encounter, Performed")

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

FirstPlatelet(QualifyingEncounter "Encounter, Performed")

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

FirstProcedure(Encounter "Encounter, Performed")

First(["Procedure, Performed": "General and Neuraxial Anesthesia"] FirstORProcedure
    where Global."NormalizeInterval"(FirstORProcedure.relevantDatetime, FirstORProcedure.relevantPeriod)starts during "AIR.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 "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and FirstRespiration.result is not null
    sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
).result as Decimal

FirstSodium(QualifyingEncounter "Encounter, Performed")

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

FirstSystolicBloodPressure(QualifyingEncounter "Encounter, Performed")

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

FirstWhiteBloodCellCount(QualifyingEncounter "Encounter, Performed")

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

Global.Earliest(period Interval<DateTime>)

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

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

Global.HasStart(period Interval<DateTime>)

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

Global.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 "Carbon dioxide [Partial pressure] in Arterial blood" ("LOINC Code (2019-8)")
code "Elective (qualifier value)" ("SNOMEDCT Code (103390000)")
code "Heart rate" ("LOINC Code (8867-4)")
code "Oxygen [Partial pressure] in Arterial blood" ("LOINC Code (2703-7)")
code "pH of Arterial blood" ("LOINC Code (2744-1)")
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 "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 "Creatinine lab test" (2.16.840.1.113883.3.666.5.2363)
valueset "Degenerative Neurological Disorder" (2.16.840.1.113762.1.4.1248.92)
valueset "Elective Inpatient Encounter" (2.16.840.1.113762.1.4.1248.85)
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 and Neck Surgeries with High Risk Airway Compromise" (2.16.840.1.113762.1.4.1248.183)
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" (2.16.840.1.113762.1.4.1248.91)
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 "Obstetrics and VTE Obstetrics" (2.16.840.1.113762.1.4.1248.33)
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 "Payer" (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: 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: 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 (LOINC Code 2019-8)"
"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 (LOINC Code 2703-7)"
"Laboratory Test, Performed: pH of Arterial blood" using "pH of Arterial blood (LOINC Code 2744-1)"
"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" using "Payer (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: General and Neuraxial Anesthesia" using "General and Neuraxial Anesthesia (2.16.840.1.113762.1.4.1248.208)"
"Procedure, Performed: Head and Neck Surgeries with High Risk Airway Compromise" using "Head and Neck Surgeries with High Risk Airway Compromise (2.16.840.1.113762.1.4.1248.183)"
"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"]

```
["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 "AIR.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,
  "Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" EncounterWithSurgery
  where Global."NormalizeInterval" ( Procedure.relevantDatetime, Procedure.relevantPeriod ) starts during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)
  return {
    encounterId: EncounterWithSurgery.id,
    procedureId: Procedure.id,
    procedurecode: Procedure.code,
    procedurerank: Procedure.rank,
    proceduretime: Global."NormalizeInterval" ( Procedure.relevantDatetime, Procedure.relevantPeriod )
  }

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstAST: "FirstAST"(QualifyingEncounter)
  }

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstAlbumin: "FirstAlbumin"(QualifyingEncounter)
  }

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstArterialpH: "FirstArterialpH"(QualifyingEncounter)
  }

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstBMI: "FirstBMI"(QualifyingEncounter)
  }

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstBicarbonate: "FirstBicarbonate"(QualifyingEncounter)
  }

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstBilirubin: "FirstBilirubin"(QualifyingEncounter)
  }

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstBUN: "FirstBloodUreaNitrogen"(QualifyingEncounter)
  }

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstBodyTemp: "FirstBodyTemperature"(QualifyingEncounter)
  }

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstCarbonDioxide: "FirstCarbonDioxide"(QualifyingEncounter)
  }

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstCreatinine: "FirstCreatinine"(QualifyingEncounter)
  }

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstHeartRate: "FirstHeartRate"(QualifyingEncounter)
  }

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstHematocrit: "FirstHematocrit"(QualifyingEncounter)
  }

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstHemoglobin: "FirstHemoglobin"(QualifyingEncounter)
  }

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstLeukocyte: "FirstLeukocyte"(QualifyingEncounter)
  }

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstOxygen: "FirstOxygen"(QualifyingEncounter)
  }

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstPlatelet: "FirstPlatelet"(QualifyingEncounter)
  }

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstRespiratoryRate: "FirstRespiratoryRate"(QualifyingEncounter)
  }

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstSodium: "FirstSodium"(QualifyingEncounter)
  }

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstSystolic: "FirstSystolicBloodPressure"(QualifyingEncounter)
  }

"Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" QualifyingEncounter
  return Tuple {
    encounterId: QualifyingEncounter.id,
    firstWBCcount: "FirstWhiteBloodCellCount"(QualifyingEncounter)
  }

from
  ["Procedure, Performed"] Procedure,
  "Elective Inpatient Encounter with OR Procedure and without Obstetrical Condition" EncounterWithSurgery
  where Procedure.rank = 1
    and Global."NormalizeInterval" ( Procedure.relevantDatetime, Procedure.relevantPeriod ) starts during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(EncounterWithSurgery)
  return {
    encounterId: EncounterWithSurgery.id,
    procedureId: Procedure.id,
    procedurecode: Procedure.code,
    procedurerank: Procedure.rank,
    proceduretime: Global."NormalizeInterval" ( Procedure.relevantDatetime, Procedure.relevantPeriod )
  }

["Assessment, Performed": "Tobacco smoking status"] SmokingStatus
  with "Initial Population" QualifyingEncounter
    such that Global."NormalizeInterval" ( SmokingStatus.relevantDatetime, SmokingStatus.relevantPeriod ) starts during "AIR.HospitalizationWithObservationAndOutpatientSurgeryService"(QualifyingEncounter)
      and SmokingStatus.result is not null
      and SmokingStatus.result in "Smoking status"
  return SmokingStatus.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