1. 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.

2. Surgical complications
Proposed model for intraoperative complications is to approve use of |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

3. Revised associated with role hierarchy

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

5. Intraoperative complication

6. Injury to nerve during surgery

7. Injury to viscus/spleen during surgery

8. Intraoperative fracture

9. Intraoperative hemorrhage

10. Intraoperative complication hierarchy

11. Perioperative complications

12. Remaining issues
We did not consider approval of |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 |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