Addition of during, during AND/OR after to associated with role hierarchy Original goal of project was to develop model for intraoperative complications Model for post operative complications exists Model to be extended to include not only intraoperative and postoperative complications but also perioperative complications Although perioperative commonly refers to the period of time prior to, during and after surgery, in terms of perioperative complications, we considered perioperative as occurring during surgery, after surgery or a time interval beginning during surgery and continuing in the post operative period. Thus intraoperative and postoperative complications would be considered subtypes of perioperative complications. The preoperative period was not considered for this exercise as a complication (consequence) of surgery would not be expected to occur prior to the surgery.

Surgical complications Proposed model for intraoperative complications is to approve use of 371881003 |During (attribute)|with a range limited to procedures Concern expressed that extending range of during to include clinical findings/disorders would overlap with the co-occurrence model for combined disorders Proposed model for perioperative complication is to create a new role, during AND/OR after as a descendant of associated with and an ancestor of both during and of after Above models applicable to other procedure related complications

Revised associated with role hierarchy

Intraoperative complication Intraoperative X or X during surgery Model X Defined concept During Surgical Procedure ≡ Complication

Intraoperative complication

Injury to nerve during surgery

Injury to viscus/spleen during surgery

Intraoperative fracture

Intraoperative hemorrhage

Intraoperative complication hierarchy

Perioperative complications

Remaining issues We did not consider approval of 288556008 |Before (attribute)| at this time. It is appreciated that additional mechanisms for representation of temporal intervals in SNOMED CT such as the use of occurrence or another role with 307158003 |Temporal periods relating to physiological functions (qualifier value)| may be required in addition to before, during, during and/or after and after in order to capture other temporal relationships such as perinatal, perimenopausal and pregnancy-associated