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Tracking of procedure revisions or re-operations

All, I am looking for guidance on how to track procedure revisions or re-operations in the OMOP data model.When a patient has for example hip surgery this event is tracked in the PROCEDURE_OCCURANCE. In the event where there is an issue with the original procedure and either a revision or re-operation is required the revision or reoperation is again stored in the PROCEDURE_OCCURANCE table but I want to track the fact that this is a revision and link back to the original procedure. Is the recommended way to create this relationship to use the FACT_RELATIONSHIP table with a relationship of “revision of” or something link that?

Thanks for any feedback.
Best Regards,
Colin

Hello Colin,

Yes, this would be the right approach. According to OMOP conventions you will need to create two FACT_RELATIONSHIP records to indicate bi-directional relationships between surgery and re-surgery.

There is no designated relationship concepts for re-surgery. You may possibly use:

‘Occurs after (SNOMED)’ (44818783), ‘Occurs before (SNOMED)’ (44818881).

Hope it helps.

Rimma

Hi @ColinOrr,

I’m not sure what kind of data you are working with, but if these surgeries are CPT/HCPCS codes, then there are modifiers that usually accompany these codes to indicate these surgeries are repeat/revision codes. Modifier 76 indicates that a repeat subsequent procedure was done by the same provider. You can store the modifier information in the modifier_concept_id and qualifier_source_value fields for the re-operation procedure_occurrence record.

This might be an alternative for you and you don’t have to worry about using the fact_relationship table. If you are not using CPT/HCPCS codes, then I believe the fact_relationship table is your best bet.

Hope this helps!
Jen

Apologies for the slow response, been travelling and frantically trying to catch up now that I am back in the office. Thanks @rimma for that feedback and the info on the SNOMED codes. I will investigate that further or possibly create my own codes to support this. @jenniferduryea, I done not have CPT/HCPCS codes in the data that I am loading so I will need to go with the fact_relationship option.

As a slight aside, do you use a similar method to store bi-lateral procedures? The procedure type for each joint can be different and so needs to be tracked separately but still is performed under a single procedure identifier. Issue with this is the procedure ID is no longer unique…

t