Operative complications

Hi all. I just wanted to update everyone with the outcome of my call with the anesthesia SIG re. the definition of perioperative as pertaining to complications. The group was adamant that perioperative complications should include the time period not only during and or after surgery but prior to as well just as suggested by Ed. The rationale is that what anesthesiologists perceive as perioperative complications may not be directly caused by the surgery but rather by procedures or conditions temporally related to the surgery. I found the following article which seems to support this interpretation: Leung AA, McAlister FA, Rogers SO, Jr, Pazo , Wright A, Bates DW. Preoperative Hyponatremia and Perioperative Complications. Arch Intern Med. 2012;172(19):1474-1481. doi:10.1001/archinternmed.2012.3992. Thus I think we need to reasses the recently discussed approach to modeling Complications. I would suggest that at least for Complication of procedure we retain an associated with relationship as the causal nature and temporal sequence are unspecified. We then define preopertive as before surgery, postoperative as cuurently after surgery and perioperative as before, during or after surgery. I would rename this attribute to surrounded by or surrounding and make it a parent of the before, during and after roles. I will attach an updated owl file.

Thoughts?