Combined disorders can occur, for example:
Attributes that can be used to define such causal and temporal relationships are:
The ubiquitous use of complication is not defined in relation to criteria; a complication is really just a disorder due to another disorder or procedure. For this reason, 116223007 |Complication (disorder)| is no longer active in the SNOMED CT terminology. Instead, concepts of a disorder caused by another disorder, or for disorders following either medical or surgical procedures should be modeled using a parent of 64572001 |Disease (disorder)| or the appropriate intermediate primitive.
Descriptions with the phrase "complication of" imply causality, and thus "due to" should be used in the description instead.
Perioperative complications refer to complications temporally related to a surgical procedure. They include pre-operative, intra-operative and post-operative complications and are modeled with a parent of Disease (disorder) and a relationship consisting of Temporally related to (attribute) or an appropriate subtype with a value of <<387713003 |Surgical procedure (procedure)|. A temporal complication does not necessarily imply a causal (Due to) relationship to the surgery itself, as the complication may be related to any disorder, event, or procedure occurring either prior, during, and/or after surgery. For this reason, perioperative complications do not have a stated Due to relationship unless an underlying cause is clearly stated in the FSN.
The following naming convention applies to those conditions that occur temporally, i.e. either before, during, or after the operative episode but do not have a causal relationship.
FSN: Postoperative X (disorder)
PT: Postoperative X
88797001 |Complication of surgical procedure (disorder)| is not a subtype of perioperative complication, as it does not include a temporal relationship. Similarly, 738668004 |Perioperative complication (disorder)| is not a subtype of 88797001 |Complication of surgical procedure (disorder)|, as there is no causal relationship. Some disorders may specify both a causal and temporarily relationship and would be modeled such that they would classify under both 738668004 |Perioperative complication (disorder)| and 88797001 |Complication of surgical procedure (disorder)|.
This attribute is used to model concepts in which a clinical finding occurs after another clinical finding, procedure, or event. Neither asserting nor excluding a causal relationship, it instead emphasizes a sequence of events. Naming pattern is ‘x following y’.
123948009 |Disorder following viral disease (disorder)| occurs After 34014006 |Viral disease (disorder)|
Figure 1: Stated view of 123948009 |Disorder following viral disease (disorder)|
Post-infectious disorders are not subtypes of infectious disorders (unless the disorder is itself an infectious disease). The |After (attribute)| is used for linking post-infectious disorders with their associated infections.
The Due to and After attributes are used to model a disorder that occurs after a disorder or procedure with a causal relationship. Both the cause and the After relationship must be specified. The naming pattern is ‘due to and following’.
This attribute is used to model a preoperative complication. Strictly, a preoperative complication is a disorder that complicates the procedure, rather than being a complication of that procedure. A preoperative complication might be considered to be a disorder that exists prior to surgery that adversely affects the surgery or that results in an intraoperative or postoperative complication.
This attribute is used to model a disorder that occurs during a procedure.
Figure 2: Stated view of 713890008 |Hypoxemia during surgery (disorder)|
Due to and During attributes can be used to model a disorder that occurs during a procedure (e.g. intraoperative complication) with a causal relationship. Both a cause and a temporal relationship to the cause must be specified.
A sequela is a disorder that is a consequence, but not an unexpected outcome, that follows after another disorder, procedure, or event. These conditions are often described with the words following, after, post, sequela(e), or late effects.
Sequelae can be in the following forms:
These conditions should be modeled with After (and also Due to if there is a causal relationship).
362977000 |Sequela (disorder)| is no longer allowed as a stated supertype. Concepts currently modeled with a supertype of Sequela will be remodeled in the next few editing cycles, and |Sequela (disorder)| will eventually be inactivated. However, descriptions with the terms sequela and late effect are still permitted.
Disorder due to and following another disorder = 698737005 |Obstructive hydrocephalus due to and following meningitis (disorder)|
Figure 3: Stated view of 698737005 |Obstructive hydrocephalus due to and following meningitis (disorder)|
FSN: Disorder X [due to and] following <<disorder /<<procedure /<event
PT: Disorder X [due to and] following <<disorder /<<procedure /<event
SYN: [Disorder X as a] Sequela of <<disorder /<<procedure /<event
SYN: [Disorder X as a] Late effect of <<disorder /<<procedure /<event
Not all surgical sequelae are complications of surgery but rather expected late effects. Conditions that occur following surgery, but not necessarily Due to the surgery, are modeled only with an After relationship.
FSN: Disorder X following << 387713003 |Surgical procedure (procedure)
PT: Disorder X following << 387713003 |Surgical procedure (procedure)
Conditions that occur following surgery and are explicitly stated as causal/due to are modeled with a Due to (attribute) of << 387713003 Surgical procedure, and an After (attribute) of << 387713003 Surgical procedure.
FSN: Disorder X due to and following <<387713003 |Surgical procedure (procedure)
PT: Disorder X due to and following <<387713003 |Surgical procedure (procedure)|