Appendix A: VASQIP Adverse Event Definition and POEM Algorithm
VASQIP Clinical Definition
POEM Definition
POEM Algorithm Sources of
Evidence
Acute Renal Failure
In a patient who did not
Postoperative
“Dialysis” as a keyword search,
require dialysis preSNOMED “Acute
SNOMED CT concept search,
operatively, worsening of
Renal Failure” or
or string search in general
renal dysfunction postdialysis in
clinical notes or discharge
operatively requiring
hospitalization
summaries
hemodialysis, peritoneal
documentation or
“Acute Renal Failure” as a
dialysis, hemofiltration,
discharge summary
string search or SNOMED CT
hemodiafiltration or
concept search in general
ultrafiltration. Exclude preclinical notes or discharge
operative chronic renal
summaries
failure.
The absence of cardiac
rhythm or presence of
chaotic cardiac rhythm that
results in loss of
consciousness requiring the
initiation of any component
of basis and/or advanced
cardiac life support.
The identification of a new
blood clot or thrombus
within the venous system,
which may be coupled with
inflammation. This
diagnosis is confirmed by a
duplex, venogram, or CT
scan.
Cardiac Arrest
Post operative
evidence of cardiac
arrest, and/or
resuscitation.
“Code” (as in “pt coded”) as a
string search in general clinical
notes or discharge summaries
“Resuscitation,” “cardiac arrest,”
and “absent pulse” as a
SNOMED CT concept search in
general clinical notes
“Called” and “code” in the same
sentence as a string search in
general clinical notes.
Deep Vein Thrombosis
Postoperative
Intravenous anticoagulant drugs
SNOMED “Venous
in structured data.
thrombosis” or
“Phlebitis,” “venous thrombosis,”
“Phlebitis” in
or “thrombus” as a SNOMED CT
hospitalization
concept search in imaging notes
documentation or
“Phlebitis,” “venous thrombosis,”
discharge summary
and “thrombus” or “blood clot” but
not “carotid” as a SNOMED CT
concept search
and
“dopper,” “ultrasound” as a
SNOMED CT concept search, or
string search in the same
sentence in general clinical notes
or discharge summaries
“Vena cava filter” as a SNOMED
CT concept search in general
clinical notes
A new transmural acute
myocardial infarction
occurring during surgery or
within 30 days following
surgery as manifested by
new Q-waves on ECG.
Myocardial Infarction
Postoperative
“Myocardial infarction” (excluding
SNOMED “Q-wave
q-wave) as a SNOMED CT
Concept” and
concept search in general clinical
“Myocardial
notes
Infarction” in
“Finding of ECG Q wave” or
hospitalization
“myocardial infarction” (q-wave
documentation or
only) as a SNOMED CT concept
discharge summary
search in general clinical notes
Creatine kinase (CK) and
troponins with abnormal
laboratory results in structured
data
Inflammation of the lungs
caused primarily by
bacteria, viruses, and/or
chemical irritants, usually
manifested by chills, fever,
pain in the chest, cough,
purulent, bloody sputum.
Report as an occurrence if
the patient has pneumonia
meeting the definition of
pneumonia below AND
pneumonia not present
preoperatively.
1. Rales or dullness to
percussion on physical
examination of chest
AND any of the following:
a. New onset of purulent
sputum or change in
character of sputum
b. Organism isolate from
blood culture
c. Isolation of pathogen
from specimen obtained by
transtracheal aspirate,
bronchial brushing, or
biopsy.
Pneumonia
Postoperative
SNOMED “Lung
Consolidation” in
hospitalization
documentation or
discharge summary
Positive blood culture from
regular expression parsed
microbiology report
“Lung consolidation” or
“pneumonitis” as a SNOMED CT
concept search in general clinical
notes or discharge summaries
OR
2. Chest radiographic
examination shows new or
progressive infiltrate,
consolidation, cavitation, or
pleural effusion AND any of
the following:
a. New onset of purulent
sputum or change in
character of sputum
b. Organism isolated from
the blood
c. Isolation of pathogen
from specimen obtained by
transtracheal aspirate,
bronchial brushing, or
biopsy
d. Isolation of virus or
detection of viral antigen in
respiratory secretions
e. Diagnostic single
antibody titer (IgM) or
fourfold increase in paired
serum samples (IgG) for
pathogen
f. Histopathologic evidence
of pneumonia.”
Exclude pre-operative
pneumonia.
Lodging of a blood clot in a
pulmonary artery with
subsequent obstruction of
blood supply to the lung
parenchyma. Pulmonary
embolism is diagnosed by a
V-Q scan interpreted as
high probability of
pulmonary embolism or a
positive pulmonary
arteriogram or positive CT
angiogram or positive Spiral
CT exam.
Pulmonary Embolism
Postoperative
“Embolus” or “pulmonary
SNOMED
embolism” as a SNOMED CT
“Pulmonary
concept search in imaging notes,
Embolism” or
discharge summaries, or general
“Embolus” in
clinical notes
hospitalization
documentation or
discharge summary
Sepsis
Sepsis is the systemic
response to infection. This
syndrome is clinically
recognized by the presence
of two or more of the
following: 1) Temp >38
degrees C or <36 degrees
C; 2) HR >90 bpm; 3) RR
>20 breaths/min or PaCO2
<32 mmHg(<4.3 kPa); 4)
WBC >12,000 cell/mm3,
<4000 cells/mm3, or >10%
immature forms; 5) Anion
gap acidosis AND one of the
following: 1) positive blood
culture; 2) clinical
documentation of purulence;
3) positive culture from any
site thought to be causative
Postoperative symptomactic
urinary tract infection with
symptoms and culture or
symptoms and physician’s
diagnosis. Exclude
preoperative infection.
Postoperative
SNOMED “Systemic
Infection” in
hospitalization
documentation
“Systemic infection” as a
SNOMED CT concept search in
general clinical notes or
discharge summaries
Positive blood culture in regular
expression parsed microbiology
reports
“Septic shock” or “multi-system
organ failure” as a SNOMED CT
concept search in general
clinical notes or discharge
summaries
Urinary Tract Infection
Post operative
White blood cells (>=3) in urine
findings of a urinary
laboratory results structured data
track infection in the
“Urinary tract infection” or
clinical notes, or an
“urosepsis” as a SNOMED CT
organism in urine, or
concept search in general
white blood cells in
clinical notes or discharge
urine.
summaries
Positive urine culture in regular
expression parsed microbiology
reports
Superficial incisional, deep
incisional, or organ/space
surgical site infection that
occurs within 30 days after
operation and the infection
appears to be related to the
operation. Exclude preoperative infection.
Wound Infection
Post operative
documentation of a
wound infection
including cellulitis
“Infection of wound,”
“inflammatory morphology,”
“cellulitis,” “culture,”
“debridement,” “organism
growth,” or “necrosis” as a
SNOMED CT concept search in
general clinical notes or
discharge summaries
“Wound” as a SNOMED CT
concept search
and
“cellulitis” as a SNOMED CT
concept search occuring in the
same document in general
clinical notes or discharge
summaries
“Wound” as a SNOMED CT
concept search
and
“infection of skin subcutaneous
tissue” as a SNOMED CT
concept search occurring in the
same sentence in general
clinical notes or discharge
summaries
Positive culture (excluding
specimen types of blood, urine,
sputum, stool and unlikely sites)
in regular expression parsed
microbiology reports
“Wound infection” as a string
search in general clinical notes
or discharge summaries
Exclude case if positive for
“purulent discharge” as a
SNOMED CT concept search
found in operative reports