| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | patient(+) | 0;1 | POINTER | 2 | B | This is the name of the patient. |
| 1 | date of transplant(+) | 0;2 | DATE-TIME | Indicate date organ transplant was completed. | ||
| 2 | surgery case | 0;3 | POINTER | 130 | This is the case in the SURGERY file associated with this file entry. This field is entered if the transplant was done in a VA medical center. This field will remain blank if the transplant was done in a non-VA facility. | |
| 3 | vaco id(+) | .01;11 | NUMERIC | The VACO ID is a unique identifier provided centrally for each patient undergoing a transplant. This field is required for creating a Transplant Assessment. | ||
| 4 | recipient height | 0;4 | FREE TEXT | Indicate the Recipient's height in either inches (in) or centimeters (cm) based upon an actual measurement (if possible) or based on the Recipient's estimate. The measurement should be entered in inches (48 to 86) or centimeters (122 to 218). If you are entering the patient's height in centimeters, enter 'C' after the number of centimeters. Your answer should be in one of the following two formats. 68 (representing inches) 173C (representing centimeters) Enter NS for NO STUDY if the patient's height cannot be determined. | ||
| 5 | recipient weight | 0;5 | FREE TEXT | Indicate the Recipient's most recent weight before surgery in either pounds (lbs) or kilograms (kg) based upon an actual measurement (if possible) or based on the Recipient's estimate. The weight should be entered in pounds (50 to 700) or kilograms (23 to 318). If you are entering the patient's weight in kilograms, enter 'K' after the number of kilograms. Your answer should be in one of the following formats. 178 (weight in pounds) 80K (weight in Kilograms) Enter NS for NO STUDY if the patient's weight cannot be determined. | ||
| 9 | recipient ivig | 0;9 | SET OF CODES | 1:BEFORE TRANSPLANT 2:AFTER TRANSPLANT 3:BOTH 4:NO | Indicate if transplant recipient receives intravenous immunoglobulin (IVIG). IVIG is used to treat acute humoral rejection after organ transplantation. IVIG is also used to reduce antibody titers prophylactically to permit ABO incompatible and cross match positive renal transplants. | |
| 10 | recipient abo blood type | 0;10 | SET OF CODES | A:A B:B AB:AB O:O | This is the ABO blood type of the organ recipient. | |
| 11 | date placed on waiting list | 0;11 | DATE-TIME | Indicate date entered on UNOS Waiting List for Transplant. | ||
| 12 | recipient cmv | 0;12 | SET OF CODES | +:POSITIVE -:NEGATIVE | This is the Recipient CMV status field. The field will capture the cytomegalovirus (CMV) serologic status of the transplant recipient. | |
| 13 | recipient hla-a typing | 0;13 | FREE TEXT | This is the HLA-A typing status of the organ recipient. It is Human Leukocyte Antigen (HLA) typing - described as A, B, C, BW, DQ, & DR locus. Acceptable answers are numerical in the format of # to #,#,#,#. The numbers between commas can be from 0 to 9999. NS (No Study) is also an acceptable response for heart transplants assessments. | ||
| 14 | recipient hla-b typing | 0;14 | FREE TEXT | This is the HLA-B typing status of the organ recipient. It is Human Leukocyte Antigen (HLA) typing - described as A, B, C, BW, DQ, & DR locus. Acceptable answers are numerical in the format of # to #,#,#,#. The numbers between commas can be from 0 to 9999. NS (No Study) is also an acceptable response for heart transplants assessments. | ||
| 15 | recipient hla-c typing | 0;15 | FREE TEXT | This is the HLA-C typing status of the organ recipient. It is Human Leukocyte Antigen (HLA) typing - described as A, B, C, BW, DQ, & DR locus. Acceptable answers are numerical in the format of # to #,#,#,#. The numbers between commas can be from 0 to 9999. NS (No Study) is also an acceptable response for heart transplants assessments. | ||
| 16 | recipient hla-bw typing | 0;16 | FREE TEXT | This is the HLA-BW typing status of the organ recipient. It is Human Leukocyte Antigen (HLA) typing - described as A, B, C, BW, DQ, & DR locus. Acceptable answers are numerical in the format of # to #,#,#,#. The numbers between commas can be from 0 to 9999. NS (No Study) is also an acceptable response for heart transplants assessments. | ||
| 17 | recipient hla-dr typing | 0;17 | FREE TEXT | This is the HLA-DR typing status of the organ recipient. It is Human Leukocyte Antigen (HLA) typing - described as A, B, C, BW, DQ, & DR locus. Acceptable answers are numerical in the format of # to #,#,#,#. The numbers between commas can be from 0 to 9999. NS (No Study) is also an acceptable response for heart transplants assessments. | ||
| 18 | recipient hla-dq typing | 0;18 | FREE TEXT | This is the HLA-DQ typing status of the organ recipient. It is Human Leukocyte Antigen (HLA) typing - described as A, B, C, BW, DQ, & DR locus. Acceptable answers are numerical in the format of # to #,#,#,#. The numbers between commas can be from 0 to 9999. NS (No Study) is also an acceptable response for heart transplants assessments. | ||
| 19 | transplant comments | .02;1 | FREE TEXT | The Transplant comments include additional information not available elsewhere on this form. This field has a limit of 130 characters. | ||
| 20 | acetaminophen toxicity | .1;1 | BOOLEAN | Y:YES N:NO | Acetaminophen Toxicity is a condition as defined by development of encephalopathy within 8 weeks of onset of illness and an acetaminophen level exceeding 4000 units/liter or diagnosis as documented by an attending physician. | |
| 21 | acute liver failure | .1;2 | BOOLEAN | Y:YES N:NO | Acute Liver Failure is when a patient develops encephalopathy within 8 weeks of an onset of illness or as documented by an attending physician. | |
| 22 | lung cancer | .1;3 | BOOLEAN | Y:YES N:NO | Indicate presence or history of lung cancer with pathology report confirming diagnosis as documented by attending physician. | |
| 23 | alcoholic cirrhosis | .1;4 | BOOLEAN | Y:YES N:NO | Continued alcohol abuse in many patients will result in the development of alcoholic cirrhosis which causes permanent scarring of the liver. Answer "YES" if a diagnosis of Alcoholic cirrhosis is documented by a physician in medical record. | |
| 24 | alpha 1 anti-trypsin def | .1;5 | BOOLEAN | Y:YES N:NO | Alpha 1 Anti-Trypsin Deficiency is the genetic predisposition to produce the protein (alpha1-antitrypsin) that helps protect the lungs. Indicate if patient has diagnosis of alpha-1 anti-trypsin deficiency documented by an attending physician. | |
| 25 | bronchiectasis | .1;6 | BOOLEAN | Y:YES N:NO | Bronchiectasis is an abnormal destruction and dilation of the large airways; or a diagnosis of bronchiectasis documented by an attending physician. | |
| 26 | glomerular sclerosis/nephritis | .1;7 | BOOLEAN | Y:YES N:NO | Glomerular Sclerosis/Nephritis is kidney disease involving primarily the glomeruli. | |
| 27 | graft failure | .1;8 | BOOLEAN | Y:YES N:NO | For kidney transplants, Graft Failure is documented return to maintenance dialysis after a successful kidney transplant. For liver transplants, graft failure is failure of transplanted liver caused by the etiologic factor for which the original transplant was performed or the diagnosis of graft failure from recurrent disease documented in the medical record. | |
| 28 | hbv cirrhosis (hepatitis b) | .1;9 | BOOLEAN | Y:YES N:NO | Cirrhosis characterized by hepatitis B surface antibody, hepatitis surface antigen, and hepatitis B core antibody positive and pathology of cirrhosis on liver biopsy. | |
| 29 | hcc (hepatocellular ca) | .1;10 | BOOLEAN | Y:YES N:NO | HCC (Hepatocellular carcinoma) is characterized by the presence of a lesion on two separate liver imaging studies and at least one of the following: a vascular blush corresponding to the area of suspicion seen on other imaging studies; an alpha-fetoprotein level of >200 ng/ml; an arteriogram confirming a tumor; a biopsy confirming HCC; chemoembolization of lesion, radio frequency, cryo, or chemical ablation of the lesion; or diagnosis of hepatocellular carcinoma documented in medical record or explant pathology showing hepatocellular carcinoma. | |
| 30 | hcv cirrhosis (hepatitis c) | .1;11 | BOOLEAN | Y:YES N:NO | HCV Cirrohosis (Hepatitis C) is characterized by hepatitis C antibody positive and/or PCR positive for HCV RNA and pathology of cirrhosis on liver biopsy. | |
| 31 | donor height | 1;2 | FREE TEXT | Indicate the Donor's height in either inches (in) or centimeters (cm) based upon an actual measurement (if possible) or based on estimate. The measurement should be entered in inches (48 to 86) or centimeters (122 to 218). If you are entering the donor's height in centimeters, enter 'C' after the number of centimeters. Your answer should be in one of the following two formats. 68 (representing inches) 173C (representing centimeters) Enter NS for NO STUDY if the donor's height cannot be determined. | ||
| 32 | interstitial lung disease | .1;13 | BOOLEAN | Y:YES N:NO | Interstitial Lung Disease (ILD) refers to a group of lung diseases which affect the alveolar epithelium, pulmonary capillary endothelium, basement membrane, perivascular and perilymphatic tissues; or a diagnosis of interstitial lung disease documented by an attending physician. | |
| 33 | membranous nephropathy | .1;14 | BOOLEAN | Y:YES N:NO | This is the Membranous Nephropathy status of the organ recipient. Membranous Nephropathy is a kidney disorder resulting in disruption of kidney function because of inflammation of the glomerulus and changes in the glomerular basement membrane. | |
| 34 | metabolic | .1;15 | BOOLEAN | Y:YES N:NO | Indicate yes if one of the following diagnoses is recorded in patient's medical record: hemachromatosis, alpha1 antitrypsin deficiency, Wilson's, Banti's, lupoid. | |
| 35 | nash | .1;16 | BOOLEAN | Y:YES N:NO | Non-alcoholic steatohepatitis (or non-alcoholic fatty liver disease) - hepatitis or cirrhosis diagnosed by liver biopsy pathology or a diagnosis of non-alcoholic steatohepatitis (or non-alcoholic fatty liver disease) documented in the medical record. | |
| 36 | donor weight | 1;3 | FREE TEXT | Indicate the Donor's most recent weight before surgery in either pounds (lbs) or kilograms (kg) based upon an actual measurement (if possible) or based on estimate. The weight should be entered in pounds (50 to 700) or kilograms (23 to 318). If you are entering the donor's weight in kilograms, enter 'K' after the number of kilograms. Your answer should be in one of the following formats. 178 (weight in pounds) 80K (weight in Kilograms) Enter NS for NO STUDY if the donor's weight cannot be determined. | ||
| 37 | polycystic disease | .1;18 | BOOLEAN | Y:YES N:NO | This is Polycystic Disease status of the organ recipient. Polycystic Disease is a condition in which multiple cysts on the kidneys cause the kidneys to fail. | |
| 38 | primary biliary cholangitis | .1;19 | BOOLEAN | Y:YES N:NO | Primary Biliary Cholangitis or Cirrhosis is an autoimmune liver disease where over time an antibody created within the body attacks and destroys the bile ducts in the liver. | |
| 39 | primary sclerosing cholangitis | .1;20 | BOOLEAN | Y:YES N:NO | Indicate whether a diagnosis of Primary Sclerosing Cholangitis is documented in the medical record. | |
| 40 | pulmonary fibrosis | .1;21 | BOOLEAN | Y:YES N:NO | Pulmonary Fibrosis involves scarring of the lung. Gradually, the air sacs of the lungs become replaced by fibrotic tissue. When the scar forms, the tissue becomes thicker causing an irreversible loss of the tissue's ability to transfer oxygen into the bloodstream. Indicate if patient has diagnosis of pulmonary fibrosis documented in the medical record. | |
| 41 | pulmonary hypertension | .1;22 | BOOLEAN | Y:YES N:NO | Indicate if patient has diagnosis of pulmonary hypertension with Mean PA pressure > 35 mmHg documented in medical record. | |
| 42 | renal cancer | .1;23 | BOOLEAN | Y:YES N:NO | This is the Renal Cancer status of the organ recipient. Renal Cancer is malignant neoplasm of the kidney. | |
| 43 | sarcoidosis | .1;24 | BOOLEAN | Y:YES N:NO | Indicate if the patient was diagnosed with clinical manifestations of cardiac sarcoidosis, which is dependent upon the location and extent of granulomatous inflammation. Cardiac involvement may precede, follow, or occur concurrently with involvement of the lungs or other organs. | |
| 44 | donor race | 44;0 | MULTIPLE | 139.544 | ||
| 45 | donor gender | 1;5 | SET OF CODES | M:MALE F:FEMALE | Indicate donor's gender as "M" if male, "F" if female. | |
| 46 | donor age | 1;6 | FREE TEXT | This is the age of the donor at the time of organ harvest. Field will be automatically calculated and filled if DONOR DATE OF BIRTH entered. Enter NS for NO STUDY if the donor's age cannot be determined. | ||
| 47 | biliary stricture | .1;26 | BOOLEAN | Y:YES N:NO | Narrowing or occlusion of the bile ducts either extrahepatic (for choledochocholedochostomy or choledochojejunostomy) or intrahepatic, seen on MRCP, ERCP, or PTC or as documented in the medical record. | |
| 48 | donor abo blood type | 1;8 | SET OF CODES | A:A B:B AB:AB O:O | This is the ABO blood type of the organ donor. | |
| 49 | donor cmv | 1;9 | SET OF CODES | +:POSITIVE -:NEGATIVE | Indicate whether the donor tested positive or negative to Cytomegalovirus. | |
| 50 | las score at listing | 0;19 | NUMERIC | Lung allocation score (LAS) is a calculated value which is used by the United Network for Organ Sharing (UNOS) based upon a number of factors including age, geographic distance, lab test results, and disease diagnosis for prospective lung transplants recipients. Indicate patient Lung Allocation Score at Listing with UNOS. Enter a number between 0 and 100. | ||
| 51 | las score at transplant | 0;20 | NUMERIC | Lung allocation score (LAS) is a calculated value which is used by the United Network for Organ Sharing (UNOS) based upon a number of factors including age, geographic distance, lab test results, and disease diagnosis for prospective lung transplants recipients. Indicate patient Lung Allocation Score at Transplant with UNOS. Enter a number between 0 and 100. | ||
| 52 | meld score at listing | 0;21 | NUMERIC | Biologic Model of End Stage Liver Disease score plus the extra points as defined by UNOS (for example, for HCC or an appeal has been made for higher MELD score due to other clinical entities) at time of listing and as documented in the UNOS data base. Enter a number between 6 and 40. | ||
| 53 | biologic meld score at listing | 0;22 | NUMERIC | Actual Model of End Stage Liver Disease score using the laboratory values of bilirubin, creatinine, and INR at the time of listing and as documented in the UNOS data base. Enter a number between 6 and 40. | ||
| 54 | meld score at transplant | 0;23 | NUMERIC | Biologic Model of End Stage Liver Disease score plus the extra points as defined by UNOS (for example, for HCC, or an appeal has been made for higher MELD score due to other clinical entities) at time of transplant and as documented in the UNOS data base. Enter a number between 6 and 40. | ||
| 55 | biologic meld score at transp | .01;10 | NUMERIC | Actual Model of End Stage Liver Disease score using the laboratory values of bilirubin, creatinine, and INR at the time of transplant and as documented in the UNOS data base. Enter a number between 6 and 40. | ||
| 56 | bile leak | .11;20 | BOOLEAN | Y:YES N:NO | Evidence of extravasation of bile from the biliary tree by a cholangiogram. The contrast imaging studies to obtain a cholangiogram include: ERCP, PTC, MRCP, or tube cholangiogram. A HIDA scan can also reveal a bile leak. In addition, bile leak can be identified as documented in the medical record. | |
| 57 | unos status at time of transp | .01;9 | SET OF CODES | A:1A B:1B 2:2 | Indicate the UNOS (United Network for Organ Sharing database) status at the time the transplant procedure was performed. | |
| 58 | unos status at time of listing | 0;8 | SET OF CODES | A:1A B:1B 2:2 7:7 - ON HOLD | Indicate the UNOS (United Network for Organ Sharing database) status at the time the heart transplant procedure was listed. | |
| 59 | diabetic retinopathy | .5;1 | BOOLEAN | Y:YES N:NO | Diabetic Retinopathy is damage to the blood vessels in the retina as a consequence of diabetes mellitus. Enter YES if organ recipient is diagnosed with this condition. Otherwise, enter NO. | |
| 60 | diabetic neuropathy | .5;2 | BOOLEAN | Y:YES N:NO | Enter the Diabetic Neuropathy status of the organ recipient. Diabetic Neuropathy is damage to the nervous system as a consequence of diabetes mellitus which can include peripheral neuropathy (sensory nervous system) or autonomic neuropathy (autonomic nervous system) or as defined by the attending physician. | |
| 61 | cardiac disease | .5;3 | BOOLEAN | Y:YES N:NO | Any documented cardiac abnormality (i.e. EKG abnormality, fixed or reversible defects, cardiac disease on heart catheterization, hypertension, and hyperlipidemia). | |
| 62 | inotrope dependent pre-transp | .5;4 | BOOLEAN | Y:YES N:NO | Indicate if the patient required an inotropic agent (dobutamine, milrinone, levophed, etc.) to maintain adequate cardiac output while awaiting a donor heart. | |
| 63 | division | 8;1 | POINTER | 4 | This is the name of the institution credited for performing this transplant. | |
| 64 | donor hla-a typing | 1;10 | FREE TEXT | This is the HLA-A typing status of the organ Donor. It is Human Leukocyte Antigen (HLA) typing - described as A, B, C, BW, DQ, & DR locus. Acceptable answers are numerical in the format of # to #,#,#,#. The numbers between commas can be from 0 to 9999. NS (No Study) is also an acceptable response for heart transplants assessments. | ||
| 65 | donor hla-b typing | 1;11 | FREE TEXT | This is the HLA-B typing status of the organ Donor. It is Human Leukocyte Antigen (HLA) typing - described as A, B, C, BW, DQ, & DR locus. Acceptable answers are numerical in the format of # to #,#,#,#. The numbers between commas can be from 0 to 9999. NS (No Study) is also an acceptable response for heart transplants assessments. | ||
| 66 | donor hla-c typing | 1;12 | FREE TEXT | This is the HLA-C typing status of the organ Donor. It is Human Leukocyte Antigen (HLA) typing - described as A, B, C, BW, DQ, & DR locus. Acceptable answers are numerical in the format of # to #,#,#,#. The numbers between commas can be from 0 to 9999. NS (No Study) is also an acceptable response for heart transplants assessments. | ||
| 67 | donor hla-bw typing | 1;13 | FREE TEXT | This is the HLA-BW typing status of the organ Donor. It is Human Leukocyte Antigen (HLA) typing - described as A, B, C, BW, DQ, & DR locus. Acceptable answers are numerical in the format of # to #,#,#,#. The numbers between commas can be from 0 to 9999. NS (No Study) is also an acceptable response for heart transplants assessments. | ||
| 68 | crossmatch d/r | 3;7 | SET OF CODES | +:POSITIVE -:NEGATIVE | Crossmatch is pretransfusion testing or compatibility testing. It is a series of procedures used to give an indication of blood group compatibility between the donor and the recipient and to detect irregular antibodies in the recipient's serum. | |
| 69 | deceased donor | 3;1 | SET OF CODES | 1:DCD (Donor after Cardiac Death) 2:ECD (Extended Criteria Donor) 3:SCD (Standard Criteria Donor) 4:ECD-DCD NS:NO STUDY | Transplanted organ was harvested from a deceased donor. Acceptable answers include DCD (Donor after Cardiac Death), ECD (Extended Criteria Donor), SCD (Standard Criteria Donor), ECD-DCD, and No Study. | |
| 70 | donor date of birth | 1;1 | DATE-TIME | Enter the donor's date of birth between December 31, 1870 and today's date. | ||
| 71 | elevated pap | .55;2 | BOOLEAN | Y:YES N:NO | Elevated pulmonary artery pressure (PAP) may indicate left-to-right shunt, LV failure, mitral stenosis or pulmonary hypertension. Indicate if patient has an Elevated PAP. Mean PA pressure of > 35 mmHg for right heart catheterization measurement. | |
| 72 | donor hla-dq typing | 1;14 | FREE TEXT | This is the HLA-DQ typing status of the organ Donor. It is Human Leukocyte Antigen (HLA) typing - described as A, B, C, BW, DQ, & DR locus. Acceptable answers are numerical in the format of # to #,#,#,#. The numbers between commas can be from 0 to 9999. NS (No Study) is also an acceptable response for heart transplants assessments. | ||
| 73 | donor hla-dr typing | 1;15 | FREE TEXT | This is the HLA-DR typing status of the organ Donor. It is Human Leukocyte Antigen (HLA) typing - described as A, B, C, BW, DQ, & DR locus. Acceptable answers are numerical in the format of # to #,#,#,#. The numbers between commas can be from 0 to 9999. NS (No Study) is also an acceptable response for heart transplants assessments. | ||
| 74 | pulmonary hyper/elevated pap | .5;5 | BOOLEAN | Y:YES N:NO | Indicate if the patient has Pulmonary Hypertension or an Elevated PAP not reversible by sodium nitroprusside (Nipride). | |
| 75 | liver disease | .5;6 | BOOLEAN | Y:YES N:NO | Indicate the presence of liver disease such as positive HCV, Hep BsAg, or documented cirrhosis in organ transplant recipient. | |
| 76 | copd | .5;7 | BOOLEAN | Y:YES N:NO | Indicate if the patient has chronic obstructive pulmonary disease (COPD) resulting in functional disability, and/or hospitalization, and/or requiring chronic bronchodilator therapy, and/or an FEV1 of less than 75% of predicted. | |
| 77 | donor substance abuse | 1;4 | SET OF CODES | Y:YES N:NO NS:NO STUDY | This is any documented history of illicit or recreational drug abuse of the donor. The route may be intravenous, subcutaneous, intranasal, oral, or inhaled. The drugs may include opioids, methamphetamines, cocaine, hallucinogens, marijuana, alcohol or other substances. | |
| 78 | porto pulmonary hypertension | .5;9 | BOOLEAN | Y:YES N:NO | The pulmonary arterial vasculopathy associated with elevated pulmonary artery pressure (mean > 35mmHg) and as a consequence of severe hepatic dysfunction or as documented in the medical record. | |
| 79 | bleeding esoph/gastric varices | .5;10 | SET OF CODES | B:BLEEDING NB:NOT BLEEDING N:NO | The presence of upper gastrointestinal bleeding from esophageal or gastric varices any time in the patient's medical history. | |
| 80 | pre-transplant malignancy | .5;11 | BOOLEAN | Y:YES N:NO | This is Pre-transplant Malignancy status of the organ recipient. Pre-transplant Malignancy is any history of solid organ, blood cell, or lymph node malignancy prior to kidney transplantation. | |
| 81 | pre-transplant skin malignancy | .5;12 | BOOLEAN | Y:YES N:NO | Indicate if the patient has any neoplasm or tumor of the skin that is biopsy-proven to be malignant prior to organ transplant. | |
| 82 | other pre-trans malignancy | .5;13 | BOOLEAN | Y:YES N:NO | Indicate if patient has history of solid organ, blood cell, or lymph node malignancy (other than skin) prior to organ transplantation. | |
| 83 | recipient substance abuse | .5;14 | BOOLEAN | Y:YES N:NO | Indicate if there is any documented history of illicit or recreational drug abuse by the organ recipient. The route may be intravenous, subcutaneous, intranasal, oral, or inhaled. The drugs may include opioids, methamphetamines, cocaine, hallucinogens, marijuana, alcohol or other substances. | |
| 84 | active infection for psc | .5;15 | BOOLEAN | Y:YES N:NO | The presence of infection related to the diseased biliary tract in the native liver at the time of liver transplantation. The infection would be manifest as cholangitis, bacteremia, or biliary sepsis. | |
| 85 | warm ischemia time for organ | 3;4 | NUMERIC | Enter warm ischemia time for organ in minutes as written on transplant data sheet or operative note. This is defined by the time that the donor organ is off ice until the time of reperfusion. | ||
| 86 | acute/chronic encephalopathy | .5;17 | BOOLEAN | Y:YES N:NO | History of new onset of hepatic encephalopathy, recurrent hepatic encephalopathy, or a state of ongoing, continued hepatic encephalopathy as documented in the medical record. | |
| 87 | cold ischemia time for organ | 3;5 | NUMERIC | Enter cold ischemia time for organ in minutes as written on transplant data sheet or operative note. This is defined by the time that the donor organ is cross-clamped to the time that the donor organ is removed from the ice. | ||
| 88 | history of ascites | .5;19 | BOOLEAN | Y:YES N:NO | The presence of ascites fluid (presence of fluid accumulation in the peritoneal cavity noted on physical exam, abdominal ultrasound, or abdominal CT/MRI) at any time in the patient's medical history. | |
| 89 | total ischemia time for organ | 3;6 | NUMERIC | Enter the total ischemia time for organ in minutes which is the sum of warm ischemia time and cold ischemia time. | ||
| 90 | non-compliance (med and diet) | .5;21 | BOOLEAN | Y:YES N:NO | Enter the non-compliance (medication and diet) status of the organ recipient. This refers to documented history of nonadherence/noncompliance to medical regimens such as diet, exercise, monitoring blood sugars, attending scheduled appointments and laboratory draws when requested. | |
| 91 | on methadone | .5;22 | BOOLEAN | Y:YES N:NO | Patient who has had previous substance abuse with opioids and is currently prescribed methadone by a physician or methadone clinic. This patient would be yes for drug abuse variable as well. | |
| 92 | post-tx prophylaxis - tb | .5;23 | SET OF CODES | Y:YES N:NO NA:NOT APPLICABLE | Definition Revised (2010): Indicate whether patient is receiving post-transplant prophylaxis Tuberculosis/Antimycobacterial drugs continuously post operatively for at least 30 days. Indicate Yes if patient receiving therapy. Indicate No if patient is indicated to receive therapy but doesn't. Indicate Not Applicable if patient is not indicated to receive therapy. | |
| 94 | rejection | .11;19 | BOOLEAN | Y:YES N:NO | A diagnosis of acute rejection as made by pathologic evaluation of allograft biopsy or a diagnosis of acute rejection as documented in the medical record. | |
| 95 | iga nephropathy | .1;17 | BOOLEAN | Y:YES N:NO | IgA Nephropathy is a kidney disorder caused by deposits of the protein immunoglobulin A (IgA) inside the glomeruli within the kidney. The chronic kidney disease may progress over a period of 10 to 20 years. If this disorder leads to end-stage renal disease, the patient must go on dialysis or receive a kidney transplant. | |
| 96 | calcineurin inhibitor toxicity | .11;4 | BOOLEAN | Y:YES N:NO | Cyclosporin and tacrolimus are calcineurin inhibitors and are widely used as immunosuppressive therapy. Among the toxicities of the calcineurin inhibitor class are nephrotoxicity manifest as acute renal failure, hyperkalemia with or without acidosis and progressive chronic renal failure and neurotoxicity manifest primarily as tremors and headache. | |
| 97 | lithium toxicity | .11;9 | BOOLEAN | Y:YES N:NO | Mild to moderate acute toxic reactions may occur at lithium drug concentrations from 1.5 - 2 mmol/L, and moderate to severe reactions at concentrations above 2 mmol/L. In patients with normal renal clearance the acute toxic manifestations appear to occur in a fairly predictable sequence related to lithium concentrations. Thirst and polyuria may be followed by increased drowsiness, ataxia, tinnitus and blurred vision, indicating early intoxication. As intoxication progresses the following manifestations may be encountered: confusion, increasing disorientation, muscle twitchings, hyperreflexia, nystagmus, seizures, diarrhea, vomiting, and eventually coma and death. Long term lithium use can also cause nephrogenic diabetes insipidus and a chronic tubulointersitial nephritis with progressive chronic kidney disease leading to ESRD. | |
| 98 | obstructive uropathy from bph | .11;10 | BOOLEAN | Y:YES N:NO | Obstructive uropathy from BPH is a non-cancerous enlargement of the prostate gland causing obstruction to the free flow of urine due to narrowing of the urethra. As obstruction progresses, the bladder decompensates, increasingly larger amounts of residual urine are left behind. Infection is frequently associated with the residual urine. This can be transmitted to the upper urinary tracts, with ensuing hydroureter, hydronephrosis and progressive renal damage and if untreated to ESRD. | |
| 99 | autoimmune hepatitis | .11;11 | BOOLEAN | Y:YES N:NO | Hepatitis or cirrhosis due to immune cell attack of the liver causing inflammation and or cell death; or diagnosis of autoimmune hepatitis documented in medical record. | |
| 100 | cryptogenic cirrhosis | .11;12 | BOOLEAN | Y:YES N:NO | Cryptogenic Cirrhosis is cirrhosis of the liver by biopsy with no specific etiology for the cirrhosis. | |
| 101 | chronic rejection | .11;13 | BOOLEAN | Y:YES N:NO | The diagnosis of chronic rejection as made by pathologic evaluation or a diagnosis of chronic rejection documented in the medical record. | |
| 102 | hepatic artery thrombosis | .11;14 | BOOLEAN | Y:YES N:NO | Thrombosis of the liver allograft hepatic artery documented by ultrasound duplex, angiogram, or another vascular imaging study; or a diagnosis of hepatic artery thrombosis documented in the medical record. | |
| 103 | living donor | 3;2 | SET OF CODES | R:RELATED U:UNRELATED NS:NO STUDY | Transplanted organ was harvested from a living donor. | |
| 104 | donor with malignancy | 3;3 | SET OF CODES | Y:YES N:NO NS:NO STUDY | Indicate if the donor has or has a history of a cancer, neoplasm, or tumor that grows in an uncontrolled manner, invading nearby tissue and metastasizing (spreading) to other sites through the bloodstream. Entering 'NS' for 'No Study/Unknown' is also allowed. | |
| 105 | primary non-function | .11;16 | BOOLEAN | Y:YES N:NO | Primary Non-Function is defined as failure in the function of the liver allograft within 7 days of liver transplantation as defined by 1) or 2): 1) AST > 4999 and one or both of the following: an INR >2.4, acidosis, defined as having an arterial pH < 7.31 or venous pH of 7.25 and/or lactate > 3.9 mMol/L; 2) anhepatic candidate; or diagnosis of primary non-function documented in the medical record. | |
| 106 | second sclerosing cholangitis | .11;17 | BOOLEAN | Y:YES N:NO | A diagnosis of secondary sclerosing cholangitis in medical record. | |
| 107 | toxic exposure | .11;18 | BOOLEAN | Y:YES N:NO | Hepatitis and or necrosis of the liver due to a known hepatotoxic agent or diagnosis of toxic exposure causing liver failure as documented in medical record. | |
| 108 | hiv positive | .5;8 | BOOLEAN | Y:YES N:NO | Enter YES if organ recipient is HIV positive on laboratory test or HIV positive as documented in the medical record. Otherwise, enter NO. | |
| 109 | post-tx prophylaxis - cmv | .5;20 | BOOLEAN | Y:YES N:NO | This is the Post Transplant Prophylaxis for CMV/Antiviral Treatment status of a patient who is receiving ganciclovir, valganciclovir, or acyclovir continuously post operatively for at least 30 days. | |
| 110 | post-tx prophylaxis - pcp | .55;1 | BOOLEAN | Y:YES N:NO | This is the Post Transplant Prophylaxis for PCP/Antibacterial Treatment status of a patient receiving septra/bactrim, pentamidine, or dapsone continuously post operatively for at least 30 days. | |
| 111 | portal vein thrombosis | .11;21 | BOOLEAN | Y:YES N:NO | Thrombosis of the liver allograft portal vein documented by ultrasound duplex, angiogram, or CT angiogram or MRI; or a diagnosis of portal vein thrombosis as documented in the medical record. | |
| 112 | other cardiomyopathy | .11;15 | FREE TEXT | If the patient was diagnosed with any other form of cardiomyopathy that is not listed elsewhere on this form, specify details into the comment field. | ||
| 113 | lung disease | .55;3 | BOOLEAN | Y:YES N:NO | Indicate the presence of lung disease such as documented COPD, pulmonary hypertension, or interstitial disease in organ transplant recipient. | |
| 114 | renal impairment | .55;4 | BOOLEAN | Y:YES N:NO | Renal dysfunction is evidenced by a serum creatinine results over 1.5 mg/dl. | |
| 115 | infection req antibiotics | .5;16 | BOOLEAN | Y:YES N:NO | Indicate the presence of infection in recipient of the target organ or system requiring antibiotic treatment. | |
| 116 | bleeding/transfusions | 10;1 | BOOLEAN | Y:YES N:NO | Any transfusion (including autologous) of packed red blood cells or whole blood given from the time the patient leaves the operating room up to and including 72 hours postoperatively. Report as an occurrence for five or more units of packed red blood cell in the postoperative period including hanging blood from the OR that is finished outside of the OR. If the patient receives shed blood, autologous blood, cell saver blood or pleurovac postoperatively, this is counted if greater than four units. The blood may be given for any reason. | |
| 117 | pneumonia | 10;2 | BOOLEAN | Y:YES N:NO | Report patients with evidence of pneumonia at the time the patient is brought to the OR. Patients with pneumonia must meet ONE of the following two criteria: Criterion 1. Rales or dullness to percussion on physical examination of chest AND any of the following: a. New onset of purulent sputum or change in character of sputum b. Organism isolate from blood culture c. Isolation of pathogen from specimen obtained by transtracheal aspirate, bronchial brushing, or biopsy OR Criterion 2. Chest radiographic examination shows new or progressive infiltrate, consolidation, cavitation, or pleural effusion AND any of the following: a. New onset of purulent sputum or change in character of sputum b. Organism isolated from blood culture c. Isolation of pathogen from specimen obtained by transtracheal aspirate, bronchial brushing, or biopsy d. Isolation of virus or detection of viral antigen in respiratory secretions e. Diagnostic single antibody titer (IgM) or fourfold increase in paired serum samples (IgG) for pathogen f. Histopathologic evidence of pneumonia | |
| 118 | on ventilator >48 hours | 10;3 | BOOLEAN | Y:YES N:NO | Definition Revised (2011): Total duration of ventilator-assisted respirations during postoperative hospitalization was >48 hours. This can occur at any time during the 30-day period postoperatively. This time assessment is CUMULATIVE, not necessarily consecutive. Ventilator-assisted respirations can be via endotracheal tube, nasotracheal tube, or tracheostomy tube. | |
| 119 | cardiac arrest req cpr | 10;4 | SET OF CODES | N:NO I:INTRAOPERATIVELY P:POSTOPERATIVELY | Definition Revised (2011): Indicate if there was any cardiac arrest requiring external or open cardiopulmonary resuscitation (CPR) occurring in the operating room, ICU, ward, or out-of-hospital after the chest had been completely closed and within 30 days of surgery. Patients with AICDs that fire but the patient does not lose consciousness should be excluded. If patient had cardiac arrest requiring CPR, indicate whether the arrest occurred intraoperatively or postoperatively. Indicate the one appropriate response: - intraoperatively: occurring while patient was in the operating room - postoperatively: occurring after patient left the operating room. | |
| 120 | psychosis | .11;22 | BOOLEAN | Y:YES N:NO | Documentation in the medical record of a mental state involving a loss of contact with reality that may include hallucinations, delusional beliefs, or personality changes or the diagnosis of psychosis in the medical record. | |
| 121 | stroke/cva | 10;6 | SET OF CODES | Y:YES N:NO 1:NO SYMPTOMS 2:<24 HOURS 3:24-72 HOURS 4:>72 HOURS | VASQIP Definitions (2011): Indicate if the patient developed a new neurologic deficit with onset immediately post-operatively or occurring within the 30 days after surgery. Neurologic deficits are defined as an embolic, thrombotic, or hemorrhagic vascular accident or stroke with motor, sensory, or cognitive dysfunction (e.g., hemiplegia,hemiparesis, aphasia, sensory deficit, impaired memory). Indicate the duration as follows: 1) no symptoms 2) symptomatic duration less than 24 hours 3) symptomatic duration of 24-72 hours 4) symptomatic duration >72 hours | |
| 122 | coma > 24 hours postop | 10;7 | BOOLEAN | Y:YES N:NO | Definition Revised (2011): Indicate if either postoperatively or within 30 days of surgery there was a significantly decreased level of consciousness (exclude transient disorientation or psychosis) for greater than or equal to 24 hours as evidenced by lack of response to deep, painful stimuli. Do not include drug-induced coma (e.g. Propofol drips, etc.) | |
| 123 | superficial incisional ssi | 10;8 | BOOLEAN | Y:YES N:NO | Definition Revised (2004): Superficial incisional SSI is an infection that occurs within 30 days after the operation and infection involves only skin or subcutaneous tissue of the incision and at least one of the following: - Purulent drainage, with or without laboratory confirmation, from the superficial incision. - Organisms isolated from an aseptically obtained culture of fluid or tissue from the superficial incision. - At least one of the following signs or symptoms of infection: pain or tenderness, localized swelling, redness, or heat and superficial incision is deliberately opened by the surgeon, unless incision is culture-negative. - Diagnosis of superficial incisional SSI by the surgeon or attending physician. Do not report the following conditions as SSI: - Stitch abscess (minimal inflammation and discharge confined to the points of suture penetration). - Infected burn wound. - Incisional SSI that extends into the fascial and muscle layers (see deep incisional SSI). | |
| 124 | deep incisional ssi | 10;9 | BOOLEAN | Y:YES N:NO | Definition Revised (2004): Deep Incision SSI is an infection that occurs within 30 days after the operation and the infection appears to be related to the operation and infection involved deep soft tissues (e.g., fascial and muscle layers) of the incision and at least one of the following: - Purulent drainage from the deep incision but not from the organ/space component of the surgical site. - A deep incision spontaneously dehisces or is deliberately opened by a surgeon when the patient has at least one of the following signs or symptoms: fever (>38 C), localized pain, or tenderness, unless site is culture-negative. - An abscess or other evidence of infection involving the deep incision is found on direct examination, during reoperation, or by histopathologic or radiologic examination. - Diagnosis of a deep incision SSI by a surgeon or attending physician. Note: - Report infection that involves both superficial and deep incision sites as deep incisional SSI. - Report an organ/space SSI that drains through the incision as a deep incisional SSI. | |
| 125 | systemic sepsis | 10;10 | BOOLEAN | Y:YES N:NO | Definition Revised (2007): Sepsis is a vast clinical entity that takes a variety of forms. The spectrum of disorders spans from relatively mild physiologic abnormalities to septic shock. Please report the most significant level using the criteria below: 1. Sepsis: Sepsis is the systemic response to infection. Report this variable if the patient has clinical signs and symptoms of SIRS. SIRS is a widespread inflammatory response to a variety of severe clinical insults. This syndrome is clinically recognized by the presence of two or more of the following: - Temp >38 degrees C or <36 degrees C - HR >90 bpm - RR >20 breaths/min or PaCO2 <32 mmHg(<4.3 kPa) - WBC >12,000 cell/mm3, <4000 cells/mm3, or >10% immature (band) forms - Anion gap acidosis: this is defined by either: [Na + K] - [Cl + HCO3 (or serum CO2)]. If this number is greater than 16, then an anion gap acidosis is present. or Na - [Cl + HCO3 (or serum CO2)]. If this number is greater than 12, then an anion gap acidosis is present. and one of the following: - positive blood culture - clinical documentation of purulence or positive culture from any site thought to be causative 2. Severe Sepsis/Septic Shock: Sepsis is considered severe when it is associated with organ and/or circulatory dysfunction. Report this variable if the patient has the clinical signs and symptoms of SIRS or sepsis AND documented organ and/or circulatory dysfunction. Examples of organ dysfunction include: oliguria, acute alteration in mental status, acute respiratory distress. Examples of circulatory dysfunction include: hypotension, requirement of inotropic or vasopressor agents. * For the patient that had sepsis preoperatively, worsening of any of the above signs postoperatively would be reported as a postoperative Examples: A patient comes into the emergency room with signs of sepsis - WBC 31, Temperature 104. CT shows an abdominal abscess. He is given antibiotics and is then taken emergently to the OR to drain the abscess. He receives antibiotics intraoperatively. Postoperatively his WBC and Temperature are trending down. POD#1 WBC 24, Temp 102 POD#2 WBC 14, Temp 100 POD#3 WBC 10, Temp 99 This patient does not have postoperative sepsis as his WBC and Temperature are improving each postoperative day. Patient comes into the ER with s/s of sepsis - WBC 31, Temp 104. CT shows an abdominal abscess. He is given antibiotics and is taken emergently to the OR to drain the abscess. He receives antibiotics intraoperatively. Postoperatively his WBC and Temp are as follows: POD#1 WBC 28, Temp 103 POD#2 WBC 24, Temp 102.6 POD#3 WBC 22, Temp 102 POD#4 WBC 21, Temp 101.6 POD#5 WBC 30, Temp 104 This patient does have postoperative sepsis because on postoperative day #5, his WBC and Temperature increase. The patient is having worsening of the defined signs of sepsis. | |
| 126 | return to surgery w/i 30 days | 10;11 | BOOLEAN | Y:YES N:NO | This field documents returns to the operating room including all surgical procedures that required the patient to be taken to the surgical operating room for intervention of any kind. | |
| 127 | seizures | .11;23 | BOOLEAN | Y:YES N:NO | Documentation of a sudden change in behavior due to an excessive electrical activity in the brain or the diagnosis of seizure in the medical record. | |
| 128 | emphysema | .1;12 | BOOLEAN | Y:YES N:NO | Emphysema is a chronic obstructive pulmonary disease that is caused by loss of elasticity of the lung tissue from destruction of structures supporting the alveoli and/or destruction of capillaries feeding the alveoli which often results in shortness of breath. Indicate if the patient has a diagnosis of emphysema documented by an attending physician. | |
| 129 | other diagnosis | .1;25 | FREE TEXT | If the patient was diagnosed with any other condition that is not listed elsewhere on this form, specify details into the comment field. Free text field will have a limit of 50 characters. | ||
| 130 | new mechanical circulatory | 10;5 | SET OF CODES | N:NO I:INTRAOPERATIVELY P:POSTOPERATIVELY | Definition Revised (2004): Indicate if the patient left the operating room suite with or required post-op placement of a new IABP, ECMO, or VAD for circulatory support within 30 days perioperatively. A "yes" response is appropriate even if the pump is only used for a short time perioperatively. A "yes" response, however, is only correct if the patient did not enter the operating room with this same mechanical circulatory support, and the device insertion occurred AFTER the induction of anesthesia. If patient had/required new mechanical circulatory support, indicate whether the placement occurred intraoperatively or postoperatively. Indicate the one appropriate response: - intraoperatively: occurring while patient was in the operating room. - postoperatively: occurring after patient left the operating room. A "no" response is appropriate if the circulatory support device was placed as a prophylaxis before the induction of anesthesia; however, if it was placed for any reason after the induction of anesthesia, then a "yes" response is appropriate. A "no" response is also appropriate if the primary operation is to insert a ventricular assist device. | |
| 131 | preop functional health status | .5;18 | SET OF CODES | I:INDEPENDENT P:PARTIALLY DEPENDENT T:TOTALLY DEPENDENT U:UNKNOWN | Definition Revised (2008): This is a question that focuses on the patient's abilities to perform activities of daily living (ADLs) in the 30 days prior to surgery. Activities of daily living are defined as 'the activities usually performed in the course of a normal day in a person's life'. ADLs include: bathing, feeding, dressing, toileting, and mobility. Report the corresponding level of self-care for activities of daily living demonstrated by this patient at the time the patient is being considered as a candidate for surgery (which should be no longer than 30 days prior to surgery). If the patient's status changes prior to surgery, that change should be reflected in your assessment. For this time point, report the level of functional health status as defined by the following criteria. (1) Independent: The patient does not require assistance from another person for any activities of daily living. This includes a person who is able to function independently with prosthetics, equipment, or devices. (2) Partially dependent: The patient requires some assistance from another person for activities of daily living. This includes a person who utilizes prosthetics, equipment, or devices but still requires some assistance from another person for ADLs. (3) Totally dependent: The patient requires total assistance for all activities of daily living. (4) Unknown: If unable to ascertain the functional status for the time point of 'prior to the current illness' only, report as unknown. All patients with psychiatric illnesses should be evaluated for their ability to function with or without assistance with ADLs just as the non-psychiatric patient. For instance, if a patient with schizophrenia is able to care for him/herself without the assistance of nursing care, he/she is considered independent. | |
| 132 | peripheral vascular disease | .5;25 | BOOLEAN | Y:YES N:NO | Indicate if the patient has peripheral vascular disease, defined as disease of the arteries to legs below bifurcation of aorta manifested by exertional claudication, and/or ischemic rest pain, and/or prior revascularization procedure(s) on vessels to legs, and/or absent or diminished pulses in legs, and/or angiographic evidence of noniatrogenic peripheral arterial obstruction greater than or equal to 50% of luminal diameter. | |
| 133 | graft failure date | 10;13 | FREE TEXT | This is the date of Graft Failure and return to maintenance dialysis after successful kidney transplant. System will also accept an entry for NS (No Study) | ||
| 134 | pancreas | 11;1 | SET OF CODES | S:SPK P:PAK N:NO STUDY | Occasionally, the kidney is transplanted together with the pancreas. SPK is a simultaneous pancreas transplant and kidney transplant. Both organs would be from the same donor. PAK is a pancreas transplant after a kidney transplant. | |
| 135 | glucose at time of listing | 11;2 | FREE TEXT | Glucose is blood sugar. Blood glucose helps measure pancreas function. This is the blood glucose level of organ recipient at the time of listing as a transplant candidate. Enter NS to represent "No Study" if this information is not available. | ||
| 136 | c-peptide at time of listing | 11;3 | FREE TEXT | Definition Revised (2010): C-peptide is a peptide which is made when proinsulin is split into insulin and c-peptide. Proinsulin is released from the pancreas into the blood in response to a rise in serum glucose. Acceptable answers are numerical in the format of #.#. Enter NS to represent "No Study" if this information is not available. | ||
| 137 | pancreatic duct anastomosis | 11;4 | SET OF CODES | B:BLADDER E:ENTERIC NS:NO STUDY | The pancreatic duct anastomosis refers to the anastomosis of the duodenal pouch, which is connected to the pancreas, for drainage of the digestive enzymes. The anastomosis will be to the bladder, or to the intestine (enteric). | |
| 138 | glucose post transplant | 11;5 | FREE TEXT | Glucose is blood sugar. Blood glucose helps measure pancreas function. Enter the blood glucose level of the organ recipient after transplant. | ||
| 139 | amylase post transplant | 11;6 | FREE TEXT | Amylase is an enzyme produced by the pancreas to help digest carbohydrates. It is measured by a blood level. Enter the blood amylase level of the organ recipient after transplant. Enter NS to represent "No Study" if this information is not available. | ||
| 140 | lipase post transplant | 11;7 | FREE TEXT | Lipase is a fat digesting enzyme. It is primarily made in the pancreas. Enter the blood lipase level of the organ recipient after transplant. Enter NS to represent "No Study" if this information is not available. | ||
| 141 | insulin req post transplant | 11;8 | SET OF CODES | Y:YES N:NO NS:NO STUDY | Insulin is a hormone made by the islet cells in the pancreas. It controls sugar in the blood by moving it into the cells where it can be used for energy. Indicate if insulin treatment was necessary after the transplant. | |
| 142 | oral hypoglycemics/post trans | 11;9 | SET OF CODES | Y:YES N:NO NS:NO STUDY | Oral hypoglycemics are oral medications taken to lower blood glucose levels. Indicate if oral hypoglycemics were administered to lower blood glucose levels after the transplant. | |
| 143 | pra at listing | .01;3 | NUMERIC | Indicate the Panel Reactive Antibody of organ recipient at time of listing with UNOS. PRA represents the percent of the U.S. population that the anti-human antibody in the organ recipient's blood reacts with. | ||
| 144 | pra at transplant | .01;4 | NUMERIC | Indicate the Panel Reactive Antibody of organ recipient at time of transplant. PRA represents the percent of the U.S. population that the anti-human antibody in the organ recipient's blood reacts with. | ||
| 145 | hypertension requiring meds | .55;5 | SET OF CODES | Y:YES N:NO NS:NO STUDY | Hypertension is characterized by high blood pressure repeatedly exceeding 140 over 90mm Hg - a systolic pressure above 140 with a diastolic pressure above 90. For heart transplant assessments, indicate if the patient has a documented history of hypertension with or without current treatment of antihypertensive medication(s). | |
| 146 | transfusion >4 rbc units | .55;6 | SET OF CODES | Y:YES N:NO NS:NO STUDY | Preoperative loss of blood necessitating a minimum of 5 units of whole blood/packed red cells transfused during the 72 hours prior to surgery including any blood transfused in the emergency room. | |
| 147 | *diabetes mellitus | .55;7 | SET OF CODES | N:NO D:DIET O:ORAL I:INSULIN | This field has been flagged as obsolete for VASQIP. It should no longer be used. Indicate if the patient has diabetes treated with diet, oral, and/or insulin therapy. Diabetes is defined as a metabolic disorder of the pancreas whereby the individual requires daily dosages of exogenous parenteral insulin or an oral hypoglycemic agent to prevent a hyperglycemic/metabolic acidosis. If the patient is on both Oral and Insulin therapy, indicate Insulin therapy. Indicate the one most appropriate response. No - no diagnosis of diabetes. Diet - a diagnosis of diabetes that is controlled by diet alone in the two weeks preceding surgery (the only prescribed treatment has been diabetic relief). Oral - a diagnosis of diabetes requiring therapy with an oral hypoglycemic agent in the two weeks preceding surgery. Insulin - a diagnosis of diabetes requiring daily insulin therapy in the two weeks preceding surgery. | |
| 148 | reoperation for bleeding | 10;12 | BOOLEAN | Y:YES N:NO | Definition Revised (2004): Indicate if there was any re-exploration of the thorax for suspected bleeding within 30 days of surgery. | |
| 149 | amiodarone use | .55;8 | BOOLEAN | Y:YES N:NO | Amiodarone is an antiarrhythmic agent used for various types of tachyarrhythmias, both ventricular and supraventricular arrhythmias. Indicate if the patient has a history of current or past use of Amiodarone. | |
| 150 | heparin sensitivity | .55;9 | BOOLEAN | Y:YES N:NO | Indicate if the patient has heparin sensitivity. | |
| 151 | hyperlipidemia history | .55;10 | BOOLEAN | Y:YES N:NO | Indicate if the patient has a history of elevated cholesterol, as defined as a fasting LDL level > 160 mg/dL, a fasting triglyceride level > 200 mg/dL, or current/past use of drugs (statins, niacin, fibrates) to treat elevated cholesterol levels. | |
| 152 | ventricular tachycardia | .55;11 | BOOLEAN | Y:YES N:NO | Indicate if the patient had rapid beating of the heart-paroxysmal tachycardia originating in an ectopic focus in the ventricle. | |
| 153 | prior blood transfusion | .55;12 | BOOLEAN | Y:YES N:NO | Indicate if the patient has ever received a transfusion of blood and/or blood products. | |
| 154 | creatinine on transplant day | .55;13 | NUMERIC | Indicate the patient's Serum Creatinine result (mg/dl) preoperatively evaluated closest to transplant surgery but not greater than 72 hours before surgery. | ||
| 155 | dilated cardiomyopathy | .1;27 | BOOLEAN | Y:YES N:NO | Indicate whether the patient was diagnosed with dilated cardiomyopathy (DCM) as characterized by dilation and impaired contraction of one or both ventricles - generally with an ejection fraction < 40% | |
| 156 | coronary artery disease | .11;1 | BOOLEAN | Y:YES N:NO | Indicate if patient was diagnosed with coronary plaque formation or endothelial inflammation of the lining of the coronary arteries. | |
| 157 | ischemic cardiomyopathy | .11;2 | BOOLEAN | Y:YES N:NO | Indicate if the patient was diagnosed with ischemic cardiomyopathy, primarily due to fixed or non-fixed ischemic damage of the myocardium. | |
| 158 | alcoholic cardiomyopathy | .11;3 | BOOLEAN | Y:YES N:NO | Indicate if the patient was diagnosed with myocardial disease due to chronic alcoholism. | |
| 159 | valvular cardiomyopathy | .11;5 | BOOLEAN | Y:YES N:NO | Indicate if the patient was diagnosed with valvular cardiomyopathy thought to be secondary to valvular disease, usually of the aortic or mitral valve. | |
| 160 | idiopathic cardiomyopathy | .11;6 | BOOLEAN | Y:YES N:NO | Indicate if the patient was diagnosed with idiopathic cardiomyopathy. | |
| 161 | viral cardiomyopathy | .11;7 | BOOLEAN | Y:YES N:NO | Indicate if the patient was diagnosed with viral cardiomyopathy. Viral infection is the most common cause of myocarditis and has been implicated in the development of DCM. Viruses known to involve the myocardium include Coxsackievirus, Influenza virus, Adenovirus, Echovirus, Cytomegalovirus, and Human Immunodeficiency Virus. | |
| 162 | peripartum cardiomyopathy | .11;8 | BOOLEAN | Y:YES N:NO | Indicate if the patient was diagnosed with cardiac failure in the period before, during, or after pregnancy and delivery. | |
| 163 | pvr before vasodilation | .01;5 | NUMERIC | Indicate the patient's Pulmonary Vascular Resistance measured in Woods Units before vasodilation in numerical format of #.# . Entering "NS" for "No Study/Unknown" is also allowed, if not applicable and PVR (wood units) after Vasodilation is obtained. | ||
| 164 | pvr after vasodilation | .01;6 | NUMERIC | Indicate the patient's Pulmonary Vascular Resistance measured in Woods Units after vasodilation. Entering "NS" for "No Study/Unknown" is also allowed, if not applicable and PVR (wood units) before Vasodilation is obtained. | ||
| 165 | lvef% | .01;7 | NUMERIC | Indicate the most recent pre-transplant Left Ventricular Ejection Fraction as measured by MUGA scan or Echocardiogram. | ||
| 166 | pra% | .01;8 | NUMERIC | Indicate the most recent T-cell and B-cell pre-transplant Percent Reactive Antibodies as measured by flow cyometry. | ||
| 167 | pa systolic pressure | 0;6 | FREE TEXT | For patients having a right heart catheterization, indicate the patient's pulmonary artery (PA) systolic pressure at the catheterization most recent prior to surgery. PA pressures obtained in the operating room prior to surgery are acceptable if they are obtained prior to anesthesia induction. If no right heart catheterization performed, entering "NS" for "No Study/Unknown" is also allowed. | ||
| 168 | paw mean pressure | 0;7 | FREE TEXT | For patients having a right heart catheterization, indicate the patient's mean pulmonary artery wedge (PAW) [also called pulmonary capillary] pressure or left atrial pressure measured at the catheterization most recent prior to surgery. PAW pressures obtained in the operating room prior to surgery are acceptable if they are obtained prior to anesthesia induction. If no right heart or transseptal catheterization performed, entering "NS" for "No Study/Unknown" is also allowed. | ||
| 169 | fev1 | .55;14 | FREE TEXT | Indicate the amount of forced expiratory volume in one second from the most recent pulmonary function test prior to surgery. Enter 'NS' for No Study if there has been no FEV1 measured in the year preceding surgery. | ||
| 170 | date of death | 10;19 | FREE TEXT | If the patient has died, this is the date of death. Enter NA if DATE OF DEATH is not applicable. | ||
| 171 | *current smoker | .55;15 | SET OF CODES | 1:NEVER A SMOKER 2:WITHIN 2 WEEKS OF SURGERY 3:2 WEEKS TO 3 MONTHS PRIOR TO SURGERY 4:>3 MONTHS PRIOR TO SURGERY (REMOTE SMOKER) | This field has been flagged as obsolete for VASQIP. It should no longer be used. Indicate the patient's smoking status from information from the patient, or the chart, that best describes the patient's use of tobacco in any form (pipe, cigar, cigarette, tobacco chew). If more than one representation is found, please record according to the most conservative (most recent) quit date: 1 = Never a Smoker 2 = Smoking w/i 2 weeks prior to surgery 3 = Smoking w/i 2 weeks to 3 months prior to surgery 4 = Remote Smoker (more than 3 months prior to surgery) | |
| 172 | prior mi | .55;16 | SET OF CODES | 0:NONE 1:LESS THAN OR EQUAL 7 DAYS OF SURG 2:GREATER THAN 7 DAYS PRIOR TO SURG | Indicate whether the patient has a history of a non-Q-wave or Q-wave myocardial infarction as diagnosed in his or her medical records. Myocardial infarction may be indicated by the presence of one of the following: 1) typical rise and fall in biochemical markers, 2) cardiac pain, 3) typical ECG changes (new Q-waves, ST segment elevation or depression). In the absence of the above supporting data, a clear statement or diagnosis of prior myocardial infarction in the chart will suffice; however, the patient's statement, "I've had a heart attack" is insufficient evidence. Indicate the one appropriate response: None - The patient has never had a previous Myocardial Infarction. <=7 days of surg - The patient had a previous Myocardial Infarction within 7 days prior to surgery. >7 days prior to surg - The patient had a Myocardial Infarction more than 7 days prior to surgery." The field for PRIOR MI shall be added to the data entry option for Non-VA heart transplant assessments. | |
| 173 | num of prior heart surgeries | .55;17 | SET OF CODES | 0:None 1:1 2:2 3:3 >:>3 | Indicate the number of previous heart surgeries the patient has had upon current admission, by referencing the patient history. The prior heart surgery/ies would have occurred during a separate hospitalization (more than 30 days prior to current surgery). Both on and off-pump cardiac surgical procedures should be considered. Count all surgical procedures performed during separate hospital admissions (not the number of grafts, and not additional procedures performed during the same admission due to a postoperative occurrence). Indicate the one appropriate response: 0, 1, 2, 3, >3. | |
| 174 | *cerebral vascular disease | .55;18 | BOOLEAN | Y:YES N:NO | This field has been flagged as obsolete for VASQIP. It should no longer be used. Indicate if the patient has cerebral vascular disease, defined as disease of the arteries to the head manifested by previous stroke (cerebral vascular accident), and/or transient ischemic attack (TIA), and/or prior surgical repair (e.g., carotid endarterectomy), and/or greater than or equal to 50% obstruction of luminal diameter documented by contrast angiography or duplex ultrasound examination. (NOTE: Stroke should be broadly interpreted to include intracerebral or subarachnoid bleeding.) | |
| 175 | congestive heart failure | .55;19 | SET OF CODES | 1:Class I 2:Class II 3:Class III 4:Class IV | Indicate whether the patient has congestive heart failure if the patient chart or patient self-report indicates a history of congestive heart failure within the 30 days before surgery. Congestive heart failure is defined as the inability of the heart to pump a sufficient quantity of blood to meet the metabolic needs of the body or can do so only at increased ventricular filling pressure. Common manifestations are identified: From the history: 1) Abnormal limitation in exercise tolerance due to dyspnea, fatigue or angina. 2) Orthopnea (dyspnea on lying supine). 3) Paroxysmal nocturnal dyspnea (PND) - awakening from sleep with dyspnea which is relieved by assuming an upright posture). From the physical examination: 4) Increased jugular venous pressure. 5) Pulmonary rales on physical examination. From the chest x-ray: 6) Cardiomegaly, and 7) Pulmonary vascular engorgement. The New York Heart Association functional classification is commonly used as a subjective assessment of the severity of congestive heart failure. If none of the above manifestations have been present or congestive heart failure is not mentioned as an active problem in the 30 days before surgery, indicate Class I. Any mention of above manifestations requires the indication of a stage other than Class I. Indicate the one most appropriate response: Class I - cardiac disease, no symptoms of abnormal fatigue, dyspnea, or angina. Class II - slight limitation of physical activity by fatigue, dyspnea , or angina. The patient gets unusual fatigue, dyspnea, and/or angina only upon performing more strenuous activities, such as climbing two or more flights of stairs without stopping. Class III - marked limitation of physical activity by fatigue, dyspnea, or angina. The patient gets unusual fatigue, dyspnea, and/or angina upon performing ordinary activities, such as walking several blocks or climbing a flight of stairs. Class IV - symptoms at rest and/or inability to carry out any physical activity without symptoms of fatigue, dyspnea or angina. The patient has symptoms of unusual fatigue, dyspnea, and/or angina at rest or when performing minimal activity, such as walking across the room. | |
| 176 | iv ntg within 48 hours | .55;20 | BOOLEAN | Y:YES N:NO | Indicate if the patient was administered nitroglycerin intravenously within 48 hours prior to surgery. | |
| 177 | current digoxin use | .55;21 | BOOLEAN | Y:YES N:NO | Indicate if the patient has used a digitalis preparation (digoxin, Lanoxin, digitoxin, etc.) within the two weeks prior to surgery. | |
| 178 | current diuretic use | .55;22 | BOOLEAN | Y:YES N:NO | Indicate if the patient has used any diuretic preparation within the two weeks prior to surgery. | |
| 179 | preop circulatory device | .55;23 | SET OF CODES | N:NONE I:IABP V:VAD A:ARTIFICIAL HEART O:OTHER | Indicate whether there was any use of any device to assist ventricular function at the time the patient presents for surgery. Indicate the one appropriate response: None - No New Mechanical Circulatory Device was placed. IABP - An intra-aortic balloon pump was placed to assist ventricular function. VAD - A ventricular assist device (e.g., LVAD, BIVAD) was placed to assist ventricular function. Artificial Heart - An artificial heart was placed to assist ventricular function. Other - Another type of Mechanical Circulatory Device was placed. | |
| 181 | assessment status | RA;1 | SET OF CODES | I:INCOMPLETE C:COMPLETE T:TRANSMITTED | This is the current status of the surgery risk assessment. When creating a new assessment, the status will automatically be entered as 'INCOMPLETE'. Upon completion of the assessment, this field will be updated to 'COMPLETED'. After the assessment is transmitted, this field will be automatically updated to 'TRANSMITTED'. | |
| 182 | transplant type | RA;2 | SET OF CODES | K:KIDNEY LI:LIVER LU:LUNG H:HEART | The Transplant Type is the name of the organ transplanted. This field only allows selection of KIDNEY, LIVER, LUNG, or HEART. | |
| 183 | re-transmission | RA;3 | SET OF CODES | 0:NOT RE-TRANSMITTED 1:RE-TRANSMITTED | This determines whether the assessment will be re-transmitted. It will automatically be set to '1' when a transmitted assessment is updated to an INCOMPLETE status to edit and re-transmit. | |
| 184 | date transmitted | RA;4 | DATE-TIME | This is the date (or date/time) that this surgery risk assessment was transmitted. | ||
| 185 | va/non va indicator(+) | RA;5 | SET OF CODES | V:VA N:NON-VA | This field indicates whether the transplant was performed in VA facility or Non-VA facility. | |
| 187 | date started dialysis | .01;1 | FREE TEXT | Indicate date that patient began renal replacement therapy due to renal failure. System will also accept an entry for NS (No Study). | ||
| 188 | date of last transmission | RA;8 | DATE-TIME | This is the date of the retransmission if this assessment has been retransmitted to the national database. If there was no retransmission of this assessment, this is the date of the original transmission. | ||
| 189 | tracheostomy | 10;14 | BOOLEAN | Y:YES N:NO | Indicate if a procedure to cut into the trachea and insert a tube to overcome tracheal obstruction or to facilitate extended mechanical ventilation was performed within 30 days postoperatively. | |
| 190 | mediastinitis | 10;15 | BOOLEAN | Y:YES N:NO | Indicate if the patient developed a bacterial infection involving the sternum or deep to the sternum requiring drainage and anti-microbial therapy diagnosed within 30 days after surgery. | |
| 191 | renal failure req. dialysis | 10;16 | BOOLEAN | Y:YES N:NO | VASQIP Definition (2011): Indicate if the patient developed new renal failure requiring renal replacement therapy or experienced an exacerbation of preoperative renal failure requiring initiation of renal replacement therapy (not on renal replacement therapy preoperatively) within 30 days postoperatively. Renal replacement therapy is defined as venous to venous hemodialysis [CVVHD], continuous venous to arterial hemodialysis [CVAHD], peritoneal dialysis, hemofiltration, hemodiafiltration or ultrafiltration. TIP: If the patient refuses dialysis, report as an occurrence because he/she did require dialysis. | |
| 192 | perioperative mi | 10;17 | BOOLEAN | Y:YES N:NO | VASQIP Definition (2011): Indicate the presence of a peri-operative MI that occurs either intraoperatively or postoperatively within 30 days: Non-Cardiac Surgery: A new transmural acute myocardial infarction as manifested by new Q-waves on ECG. (Non-Q-wave infarctions should be entered under "Other Occurrence"). Cardiac Surgery: A new transmural acute myocardial infarction as manifested by at least one of the following criteria: 1. Development of new Q-waves in two or more contiguous ECG leads; 2. Evolutionary ST-segment elevations; 3. New or presumably new LBBB pattern on the ECG. | |
| 193 | operative death | 10;18 | BOOLEAN | Y:YES N:NO | Indicate if the patient died within the 30 days after surgery in or out of the hospital regardless of cause; or within the index hospitalization regardless of cause; or patient died greater than 30 days as a direct result of a perioperative occurrence of the surgery (e.g., mediastinitis). | |
| 197 | plasmapheresis | .01;2 | SET OF CODES | 1:BEFORE TRANSPLANT 2:AFTER TRANSPLANT 3:BOTH 4:NO | Plasmapheresis is the procedure of removing, treating, and returning of plasma from blood circulation. It is an extracorporeal therapy. | |
| 198 | tobacco use | .55;24 | SET OF CODES | 1:NEVER USED TOBACCO 2:NO USE IN LAST 12 MOS 3:CIGARETTES ONLY 4:OTHER (NO CIGARETTES) 5:CIGARETTES PLUS OTHER | VASQIP Definitions (2011): Indicate the patient's type of tobacco product used in the 12 months prior to surgery. Select one: 1 = Never used tobacco 2 = No tobacco use in the last 12 months 3 = Cigarettes only 4 = Pipe, cigar, snuff, or chewing tobacco only (no cigarettes) 5 = Cigarettes plus one or more of pipe, cigar, snuff, or chewing tobacco | |
| 199 | tobacco use timeframe | .55;25 | SET OF CODES | 1:WITHIN 2 WEEKS 2:2 WKS TO 3 MOS 3:3 TO 12 MONTHS NA:NOT APPLICABLE | VASQIP Definitions (2011): If the patient used tobacco products in the 12 months prior to surgery, indicate the timeframe: 1 = within the 2 weeks prior to surgery 2 = between 2 weeks and 3 months prior to surgery 3 = between 3 months and 12 months prior to surgery | |
| 200 | diabetes mellitus chronic | .55;26 | SET OF CODES | 1:NO 2:DIET 3:ORAL 4:INSULIN | VASQIP Definitions (2011): Indicate the chronic, long-term treatment regimen for patients with a diagnosis of Diabetes Mellitus. Diabetes Mellitus is defined as a metabolic disorder of the pancreas whereby the individual requires diet modification, daily dosages of exogenous parenteral insulin or an oral hypoglycemic agent to prevent a hyperglycemic/metabolic acidosis. If the patient is on both Oral and Insulin therapy, indicate Insulin therapy. No - no diagnosis of diabetes Diet - a diagnosis of diabetes that is controlled by diet alone Oral - a diagnosis of diabetes requiring therapy with an oral hypoglycemic agent Insulin - a diagnosis of diabetes requiring daily insulin therapy | |
| 201 | diabetes mellitus preop mgmt | .55;27 | SET OF CODES | 1:NO 2:DIET 3:ORAL 4:INSULIN | VASQIP Definitions (2011): Indicate the treatment regimen for patients with a diagnosis of Diabetes Mellitus in the two weeks prior to surgery. Diabetes Mellitus is defined as a metabolic disorder of the pancreas whereby the individual requires diet modification, daily dosages of exogenous parenteral insulin or an oral hypoglycemic agent to prevent a hyperglycemic/metabolic acidosis. If the patient is on both Oral and Insulin therapy, indicate Insulin therapy. No - no diagnosis of diabetes Diet - a diagnosis of diabetes that is controlled by diet alone in the two weeks preceding surgery Oral - a diagnosis of diabetes requiring therapy with an oral hypoglycemic agent in the two weeks preceding surgery Insulin - a diagnosis of diabetes requiring daily insulin therapy in the two weeks preceding surgery | |
| 202 | cvd repair/obstruction | .55;28 | SET OF CODES | 0:NO CVD 1:YES - NO SURGICAL REPAIR 2:YES - PRIOR SURGICAL REPAIR | VASQIP Definitions (2011): Select one of the following if patient has indication of Cerebrovascular Disease (CVD): 0 = No CVD indication 1 = Yes, CVD indication by documented obstruction of carotid artery luminal diameter greater than or equal to 50% obstruction of the carotid artery documented by contrast angiography or duplex ultrasound examination which did not result in surgical repair 2 = Yes, CVD indication resulting in prior carotid artery surgical repair (e.g., carotid endarterectomy or stenting) | |
| 203 | history of cvd | .55;29 | SET OF CODES | 0:NO CVD 1:HISTORY OF TIA'S 2:CVA/STROKE - NO NEURO DEFICIT 3:CVA/STROKE W/ NEURO DEFICIT | VASQIP Definitions (2011): Indicate if the patient has a history of cerebrovascular accident by selecting one of the following indications: (If multiple events, select the one with greatest severity.): 0 = No CVD 1 = History of Transient Ischemic Attacks: Transient ischemic attacks (TIAs) are focal neurologic deficits (e.g. numbness of an arm or amaurosis fugax) of sudden onset and brief duration (usually <30 minutes ), which usually reflect dysfunction in a cerebral vascular distribution. These attacks may be recurrent and, at times, may precede a stroke. 2 = CVA/Stroke with no neurological deficit: History of a cerebrovascular accident (embolic, thrombotic, or hemorrhagic) with neurologic deficit(s) lasting at least 30 minutes, but no current residual neurologic dysfunction or deficit 3 = CVA/Stroke with neurological deficit: History of a cerebrovascular accident (embolic, thrombotic, or hemorrhagic) with persistent residual motor, sensory, or cognitive dysfunction (e.g., hemiplegia, hemiparesis, aphasia, sensory deficit, impaired memory) |
Not Referenced