Obstetric Neuraxial Anesthesia Start Time

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Description

This phenotype is used to determine the start time of neuraxial anesthesia for obstetric delivery cases. Obstetric delivery cases are first identified using the Obstetric Anesthesia Type Phenotype. Neuraxial start times will result for both vaginal delivery cases that have documentation of a labor epidural and for cesarean delivery cases.

Limitation

Accuracy of this phenotype is dependent upon provider documentation and appropriate variable mapping to necessary MPOG concepts- see logic section for complete list. This phenotype is validated on obstetric delivery cases only as determined by the Obstetric Anesthesia Type Phenotype. It is not validated for determining neuraxial start times for other non-obstetric procedures.

Data quality is limited to individual site documentation accuracy, completeness, and variable mapping, which is performed by each site, independently. MPOG, as the coordinating center, reviews data quality at each data upload and monthly via Data Diagnostics and Case Validation tools. This review, while thorough, may not contain all data elements relevant to this phenotype and thus should be carefully reviewed by the user.

Value Type

Enumeration

Value	Value Code	Definition

Return Columns

Name	Data Type

Granularity

Logic

The Obstetric Neuraxial Start Time phenotype considers specific MPOG concepts and returns the earliest date/time associated with those concepts for a given case. This phenotype considers observed date/time for all notes except 50392, which considers both observed time and the timestamp found in the value text of the note. This phenotype considers the concepts used in the 'Anesthesia Technique Neuraxial' phenotype with several exclusions and additions. Date/Times within one week of the case are accepted.

Considered MPOG Concepts:

Concepts from the 'Anesthesia Type: Neuraxial (2)' phenotype

- 2005 Epidural Medication route
- 50034 Neuraxial – Vertebral interspace final (unspecified)
- 50050 Labor epidural start
- 50146 Neuraxial technique patient position
- 50147 Neuraxial- Spinal vertebral interspace final
- 50148 Neuraxial- Spinal needle approach
- 50150 Neuraxial- Spinal needle diameter (gauge)
- 50151 Neuraxial- Spinal needle length (cm)
- 50153 Neuraxial- Spinal dermatomal level achieved
- 50154 Epidural anesthesia catheter placement note
- 50156 Epidural needle approach
- 50159 Epidural needle length (cm)
- 50162 Epidural loss of resistance depth (cm)
- 50163 Epidural catheter type or brand
- 50164 Epidural catheter withdrawn to depth (cm)
- 50165 Epidural dermatomal level achieved
- 50165 Epidural dermatomal level achieved
- 50166 Epidural parasthesias during placement
- 50329 Neuraxial technique sterile prep and drape note
- 50330 Neuraxial technique sterile prep type detail
- 50333 Neuraxial technique subcutaneous skin infiltrated with local
- 50335 Neuraxial insertion paresthesia assessment- note
- 50336 Neuraxial insertion paresthesia yes / no detail
- 50338 Neuraxial insertion aspiration of blood or CSF- detail
- 50339 Epidural catheter withdrawn to depth (cm) - detail
- 50344 Epidural catheter secured
- 50347 Epidural meniscus fall assessment - note
- 50348 Epidural meniscus fall yes / no - detail
- 50349 Epidural test dose administered - note
- 50350 Epidural test dose administered - number of ML detail
- 50351 Neuraxial - Spinal placement CSF observed note
- 50352 Neuraxial - Spinal placement CSF observed yes / no detail
- 50353 Neuraxial - Spinal placement Blood observed in spinal needle
- 50354 Neuraxial - Spinal placement Blood observed yes / no detail
- 50363 Neuraxial technique - Sensory Level Tested Left Note
- 50364 Neuraxial technique - Sensory Level Left Detail
- 50365 Neuraxial technique - Sensory Level Left Testing Device Deta
- 50366 Neuraxial technique - Sensory Level Tested Right Note
- 50367 Neuraxial technique - Sensory Level Right Level Detail
- 50368 Neuraxial technique - Sensory Level Right Testing Device Det
- 50370 Neuraxial technique - Bilateral Sensory Level Tested Note
- 50371 Neuraxial technique - Bilateral Sensory Level Detail
- 50372 Neuraxial technique - Bilateral Sensory Level Testing Device
- 50614 Neuraxial technique- Combined spinal/epidural technique note
- 50677 Regional- Block Location
- 50679 Neuraxial - complications
- 50680 Neuraxial- spinal performed
- 50691 Categorized note- neuraxial anesthesia
- 100313 Spinal access type
The following concepts from the 'Anesthesia Type: Neuraxial (2)' phenotype are explicitly excluded from this Obstetric Neuraxial Start Time Phenotype
- 50665 Procedures- other unlisted procedure
- 50051 OB labor epidural end
- 50643 Neuraxial- Epidural placed for postoperative pain control
- 50635 Regional- caudal block performed
- 50229 Induction Procedure
- 50507 Procedures- Epidural blood patch
- 90100 Actual Procedure performed
Additional concepts considered
- 2004 Intrathecal medication route
- 50690 Categorized Note- Regional anesthesia