PanCareSurPass Project HL7 FHIR Implementation Guide
1.0.0 - release 150

PanCareSurPass Project HL7 FHIR Implementation Guide, published by PanCareSurPass Project. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-eu/pcsp/ and changes regularly. See the Directory of published versions

## Logical Model: MajorSurgery - Detailed Descriptions

Active as of 2026-01-16

Definitions for the MajorSurgery logical model.

- Key Elements Table
- Differential Elements Table
- Snapshot Elements Table

Guidance on how to interpret the contents of this table can be foundhere

0. MajorSurgery
Definition | Major Surgery.
Short | Major Surgery
Control | 0..*
Is Modifier | false
Logical Model | Instances of this logical model are not marked to be the target of a Reference
2. MajorSurgery.relatedDiagnosis
Definition | Progressive number of diagnosis (1=first; 2= second; 3 = third; ?). In this field must be reported the ordinal number of the tumor diagnosis for which the surgery was performed
Short | Progressive number of diagnosis
Control | 0..1
Type | Identifier
4. MajorSurgery.relatedRelapse
Definition | Progressive number of relapse/progression (after FLT)
Short | Progressive number of relapse/progression (after FLT)
Control | 0..1
Type | Identifier
6. MajorSurgery.identifier
Definition | Progressive number of surgeries (1=first; 2= second; 3 = third; ?). In this field must be reported the ordinal number of the surgeries given.
Short | Progressive Surgery number
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
8. MajorSurgery.istitutionOfTreatment
Definition | Please Identify the institution were surgery was performed
Short | Institution of treatment
Control | 0..1
Type | BackboneElement
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
10. MajorSurgery.istitutionOfTreatment.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
12. MajorSurgery.istitutionOfTreatment.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
Slicing | This element introduces a set of slices on `MajorSurgery.istitutionOfTreatment.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
14. MajorSurgery.istitutionOfTreatment.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
16. MajorSurgery.istitutionOfTreatment.description
Definition | Institution description
Short | Institution description
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
18. MajorSurgery.istitutionOfTreatment.name
Definition | Institution name
Short | Institution name
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
20. MajorSurgery.istitutionOfTreatment.address
Definition | Institution address
Short | Institution address
Control | 0..1
Type | BackboneElement
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
22. MajorSurgery.istitutionOfTreatment.address.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
24. MajorSurgery.istitutionOfTreatment.address.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
Slicing | This element introduces a set of slices on `MajorSurgery.istitutionOfTreatment.address.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
26. MajorSurgery.istitutionOfTreatment.address.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
28. MajorSurgery.istitutionOfTreatment.address.name
Definition | Institution city
Short | Institution city
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
30. MajorSurgery.istitutionOfTreatment.address.country
Definition | Institution country
Short | Institution country
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
32. MajorSurgery.date
Definition | Date of surgery (dd/mm/yyyy). If the date is unkown or partially missed insert the year at the best of your knowledge.
Short | Date of surgery
Control | 0..1
Type | dateTime
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
34. MajorSurgery.description
Definition | Please describe the type of surgery (is a free text section, no coding). In case of surgery on pair organs specify which organ (right or left) was operated.
Short | Surgery description
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
36. MajorSurgery.affectedOrgan
Definition | Was one of these organs involved ? (Oesophagus; Abdomen; Brain; Face; Liver; Spine; Spinal Cord; Sympathetic nerves; Chest/thorax; Pelvis)
Short | Affected Organs
Control | 0..*
Type | CodeableConcept
38. MajorSurgery.sacrifiedOrgan
Definition | During surgery it is possible that some organs are 'sacrified' either to allow a radical excision of the tumor or on purpose (spleen) for staging procedures. In case of partial resection of an organ (e.g. thyroid, kidney), the organ is not 'sacrified', this type of surgery should be then reported only in the 'tumor description' For other organs (e.g. hypothalamus) the only surgical procedure on it may determine some 'sacrifcice' of function, thus in this case, the organ should be coded as 'sacrified'. (Spleen, Kidney, Eye, Lung, Ovary, Hypothalamus/hypophysis, Thyroid, Bladder, uterus Other)
Short | Sacrified Organs
Control | 0..*
Type | CodeableConcept
40. MajorSurgery.shuntApplication
Definition | Please report if a cerebrovascular shunt was inserted
Short | Shunt application
Control | 0..*
Type | BackboneElement
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
42. MajorSurgery.shuntApplication.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
44. MajorSurgery.shuntApplication.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
Slicing | This element introduces a set of slices on `MajorSurgery.shuntApplication.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
46. MajorSurgery.shuntApplication.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
48. MajorSurgery.shuntApplication.type
Definition | This is a free text section in which it is possible to specify the type (e.g. ventriculo-peritoneal) of shunt used 1 => Ventriculo-peritoneal 2 => Ventriculo atrial 3 => Subdural_peritoneal 4 => Cisternostomy (III ventricule) 5 => Other -9922 => NK
Short | Type of shunt
Control | 0..1
Type | CodeableConcept
50. MajorSurgery.shuntApplication.laterality
Definition | Please specify the laterality of the shunt 1 = right 2= left 3 = midline -9911 = not applicable -9922 => NK
Short | Laterality of shunt
Control | 0..1
Type | CodeableConcept
52. MajorSurgery.shuntApplication.isRemoved
Definition | Define if it is still in place or is already removed 1 => Still in place 2 => Removed -9911 => NA -9922 => NK
Short | In place or removed ?
Control | 0..1
Type | CodeableConcept
54. MajorSurgery.amputation
Definition | Here it is requested only a yes or no. Details should be reported in the surgery description 1 => Yes 2 => No -9911 => Not applicable -9922 => NK
Short | Amputation
Control | 0..1
Type | CodeableConcept
56. MajorSurgery.prothesis
Definition | Prothesis
Short | Prothesis
Control | 0..1
Type | BackboneElement
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
58. MajorSurgery.prothesis.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
60. MajorSurgery.prothesis.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
Slicing | This element introduces a set of slices on `MajorSurgery.prothesis.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
62. MajorSurgery.prothesis.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
64. MajorSurgery.prothesis.status
Definition | Please state if the survivor has a prosthesis either internal (e.g. hip replacement) or external (e.g. artificial arm)
Short | status
Control | 0..1
Type | CodeableConcept
66. MajorSurgery.prothesis.deviceType
Definition | Please define if prosthesis is internal (e.g. titanium bone) or external (e.g. artificial limb). Also in this case, details should be reported in the surgery description. 1 => Internal 2 => External -9922 => NK
Short | device type
Control | 0..1
Type | CodeableConcept
68. MajorSurgery.colostomy
Definition | Colostomy
Short | Colostomy
Control | 0..1
Type | BackboneElement
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
70. MajorSurgery.colostomy.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
72. MajorSurgery.colostomy.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
Slicing | This element introduces a set of slices on `MajorSurgery.colostomy.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
74. MajorSurgery.colostomy.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
76. MajorSurgery.colostomy.status
Definition | State if a colostomy was created. Details should be reported in the surgery section.
Short | status
Control | 0..1
Type | CodeableConcept
78. MajorSurgery.colostomy.isRemoved
Definition | State if a colostomy was created. Details should be reported in the surgery section. 1 => Still in place 2 => Removed -9922 =>NK
Short | In place or removed ?
Control | 0..1
Type | CodeableConcept
80. MajorSurgery.gastrostomy
Definition | State if a gastrostomy was created. Details should be reported in the surgery section. 1 => Yes 2 => No -9911 => Not applicable -9922 =>NK
Short | Gastrostomy
Control | 0..1
Type | CodeableConcept

Guidance on how to interpret the contents of this table can be foundhere

0. MajorSurgery
Definition | Major Surgery.
Short | Major Surgery
Logical Model | Instances of this logical model are not marked to be the target of a Reference
2. MajorSurgery.relatedDiagnosis
Definition | Progressive number of diagnosis (1=first; 2= second; 3 = third; ?). In this field must be reported the ordinal number of the tumor diagnosis for which the surgery was performed
Short | Progressive number of diagnosis
Control | 0..1
Type | Identifier
4. MajorSurgery.relatedRelapse
Definition | Progressive number of relapse/progression (after FLT)
Short | Progressive number of relapse/progression (after FLT)
Control | 0..1
Type | Identifier
6. MajorSurgery.identifier
Definition | Progressive number of surgeries (1=first; 2= second; 3 = third; ?). In this field must be reported the ordinal number of the surgeries given.
Short | Progressive Surgery number
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
8. MajorSurgery.istitutionOfTreatment
Definition | Please Identify the institution were surgery was performed
Short | Institution of treatment
Control | 0..1
Type | BackboneElement
10. MajorSurgery.istitutionOfTreatment.description
Definition | Institution description
Short | Institution description
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
12. MajorSurgery.istitutionOfTreatment.name
Definition | Institution name
Short | Institution name
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
14. MajorSurgery.istitutionOfTreatment.address
Definition | Institution address
Short | Institution address
Control | 0..1
Type | BackboneElement
16. MajorSurgery.istitutionOfTreatment.address.name
Definition | Institution city
Short | Institution city
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
18. MajorSurgery.istitutionOfTreatment.address.country
Definition | Institution country
Short | Institution country
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
20. MajorSurgery.date
Definition | Date of surgery (dd/mm/yyyy). If the date is unkown or partially missed insert the year at the best of your knowledge.
Short | Date of surgery
Control | 0..1
Type | dateTime
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
22. MajorSurgery.description
Definition | Please describe the type of surgery (is a free text section, no coding). In case of surgery on pair organs specify which organ (right or left) was operated.
Short | Surgery description
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
24. MajorSurgery.affectedOrgan
Definition | Was one of these organs involved ? (Oesophagus; Abdomen; Brain; Face; Liver; Spine; Spinal Cord; Sympathetic nerves; Chest/thorax; Pelvis)
Short | Affected Organs
Control | 0..*
Type | CodeableConcept
26. MajorSurgery.sacrifiedOrgan
Definition | During surgery it is possible that some organs are 'sacrified' either to allow a radical excision of the tumor or on purpose (spleen) for staging procedures. In case of partial resection of an organ (e.g. thyroid, kidney), the organ is not 'sacrified', this type of surgery should be then reported only in the 'tumor description' For other organs (e.g. hypothalamus) the only surgical procedure on it may determine some 'sacrifcice' of function, thus in this case, the organ should be coded as 'sacrified'. (Spleen, Kidney, Eye, Lung, Ovary, Hypothalamus/hypophysis, Thyroid, Bladder, uterus Other)
Short | Sacrified Organs
Control | 0..*
Type | CodeableConcept
28. MajorSurgery.shuntApplication
Definition | Please report if a cerebrovascular shunt was inserted
Short | Shunt application
Control | 0..*
Type | BackboneElement
30. MajorSurgery.shuntApplication.type
Definition | This is a free text section in which it is possible to specify the type (e.g. ventriculo-peritoneal) of shunt used 1 => Ventriculo-peritoneal 2 => Ventriculo atrial 3 => Subdural_peritoneal 4 => Cisternostomy (III ventricule) 5 => Other -9922 => NK
Short | Type of shunt
Control | 0..1
Type | CodeableConcept
32. MajorSurgery.shuntApplication.laterality
Definition | Please specify the laterality of the shunt 1 = right 2= left 3 = midline -9911 = not applicable -9922 => NK
Short | Laterality of shunt
Control | 0..1
Type | CodeableConcept
34. MajorSurgery.shuntApplication.isRemoved
Definition | Define if it is still in place or is already removed 1 => Still in place 2 => Removed -9911 => NA -9922 => NK
Short | In place or removed ?
Control | 0..1
Type | CodeableConcept
36. MajorSurgery.amputation
Definition | Here it is requested only a yes or no. Details should be reported in the surgery description 1 => Yes 2 => No -9911 => Not applicable -9922 => NK
Short | Amputation
Control | 0..1
Type | CodeableConcept
38. MajorSurgery.prothesis
Definition | Prothesis
Short | Prothesis
Control | 0..1
Type | BackboneElement
40. MajorSurgery.prothesis.status
Definition | Please state if the survivor has a prosthesis either internal (e.g. hip replacement) or external (e.g. artificial arm)
Short | status
Control | 0..1
Type | CodeableConcept
42. MajorSurgery.prothesis.deviceType
Definition | Please define if prosthesis is internal (e.g. titanium bone) or external (e.g. artificial limb). Also in this case, details should be reported in the surgery description. 1 => Internal 2 => External -9922 => NK
Short | device type
Control | 0..1
Type | CodeableConcept
44. MajorSurgery.colostomy
Definition | Colostomy
Short | Colostomy
Control | 0..1
Type | BackboneElement
46. MajorSurgery.colostomy.status
Definition | State if a colostomy was created. Details should be reported in the surgery section.
Short | status
Control | 0..1
Type | CodeableConcept
48. MajorSurgery.colostomy.isRemoved
Definition | State if a colostomy was created. Details should be reported in the surgery section. 1 => Still in place 2 => Removed -9922 =>NK
Short | In place or removed ?
Control | 0..1
Type | CodeableConcept
50. MajorSurgery.gastrostomy
Definition | State if a gastrostomy was created. Details should be reported in the surgery section. 1 => Yes 2 => No -9911 => Not applicable -9922 =>NK
Short | Gastrostomy
Control | 0..1
Type | CodeableConcept

Guidance on how to interpret the contents of this table can be foundhere

0. MajorSurgery
Definition | Major Surgery.
Short | Major Surgery
Control | 0..*
Is Modifier | false
Logical Model | Instances of this logical model are not marked to be the target of a Reference
2. MajorSurgery.relatedDiagnosis
Definition | Progressive number of diagnosis (1=first; 2= second; 3 = third; ?). In this field must be reported the ordinal number of the tumor diagnosis for which the surgery was performed
Short | Progressive number of diagnosis
Control | 0..1
Type | Identifier
4. MajorSurgery.relatedRelapse
Definition | Progressive number of relapse/progression (after FLT)
Short | Progressive number of relapse/progression (after FLT)
Control | 0..1
Type | Identifier
6. MajorSurgery.identifier
Definition | Progressive number of surgeries (1=first; 2= second; 3 = third; ?). In this field must be reported the ordinal number of the surgeries given.
Short | Progressive Surgery number
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..*
Type | Identifier
8. MajorSurgery.istitutionOfTreatment
Definition | Please Identify the institution were surgery was performed
Short | Institution of treatment
Control | 0..1
Type | BackboneElement
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
10. MajorSurgery.istitutionOfTreatment.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
12. MajorSurgery.istitutionOfTreatment.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `MajorSurgery.istitutionOfTreatment.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
14. MajorSurgery.istitutionOfTreatment.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
16. MajorSurgery.istitutionOfTreatment.description
Definition | Institution description
Short | Institution description
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
18. MajorSurgery.istitutionOfTreatment.name
Definition | Institution name
Short | Institution name
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
20. MajorSurgery.istitutionOfTreatment.address
Definition | Institution address
Short | Institution address
Control | 0..1
Type | BackboneElement
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
22. MajorSurgery.istitutionOfTreatment.address.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
24. MajorSurgery.istitutionOfTreatment.address.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `MajorSurgery.istitutionOfTreatment.address.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
26. MajorSurgery.istitutionOfTreatment.address.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
28. MajorSurgery.istitutionOfTreatment.address.name
Definition | Institution city
Short | Institution city
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
30. MajorSurgery.istitutionOfTreatment.address.country
Definition | Institution country
Short | Institution country
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
32. MajorSurgery.date
Definition | Date of surgery (dd/mm/yyyy). If the date is unkown or partially missed insert the year at the best of your knowledge.
Short | Date of surgery
Control | 0..1
Type | dateTime
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
34. MajorSurgery.description
Definition | Please describe the type of surgery (is a free text section, no coding). In case of surgery on pair organs specify which organ (right or left) was operated.
Short | Surgery description
Control | 0..1
Type | string
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
36. MajorSurgery.affectedOrgan
Definition | Was one of these organs involved ? (Oesophagus; Abdomen; Brain; Face; Liver; Spine; Spinal Cord; Sympathetic nerves; Chest/thorax; Pelvis)
Short | Affected Organs
Control | 0..*
Type | CodeableConcept
38. MajorSurgery.sacrifiedOrgan
Definition | During surgery it is possible that some organs are 'sacrified' either to allow a radical excision of the tumor or on purpose (spleen) for staging procedures. In case of partial resection of an organ (e.g. thyroid, kidney), the organ is not 'sacrified', this type of surgery should be then reported only in the 'tumor description' For other organs (e.g. hypothalamus) the only surgical procedure on it may determine some 'sacrifcice' of function, thus in this case, the organ should be coded as 'sacrified'. (Spleen, Kidney, Eye, Lung, Ovary, Hypothalamus/hypophysis, Thyroid, Bladder, uterus Other)
Short | Sacrified Organs
Control | 0..*
Type | CodeableConcept
40. MajorSurgery.shuntApplication
Definition | Please report if a cerebrovascular shunt was inserted
Short | Shunt application
Control | 0..*
Type | BackboneElement
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
42. MajorSurgery.shuntApplication.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
44. MajorSurgery.shuntApplication.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `MajorSurgery.shuntApplication.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
46. MajorSurgery.shuntApplication.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
48. MajorSurgery.shuntApplication.type
Definition | This is a free text section in which it is possible to specify the type (e.g. ventriculo-peritoneal) of shunt used 1 => Ventriculo-peritoneal 2 => Ventriculo atrial 3 => Subdural_peritoneal 4 => Cisternostomy (III ventricule) 5 => Other -9922 => NK
Short | Type of shunt
Control | 0..1
Type | CodeableConcept
50. MajorSurgery.shuntApplication.laterality
Definition | Please specify the laterality of the shunt 1 = right 2= left 3 = midline -9911 = not applicable -9922 => NK
Short | Laterality of shunt
Control | 0..1
Type | CodeableConcept
52. MajorSurgery.shuntApplication.isRemoved
Definition | Define if it is still in place or is already removed 1 => Still in place 2 => Removed -9911 => NA -9922 => NK
Short | In place or removed ?
Control | 0..1
Type | CodeableConcept
54. MajorSurgery.amputation
Definition | Here it is requested only a yes or no. Details should be reported in the surgery description 1 => Yes 2 => No -9911 => Not applicable -9922 => NK
Short | Amputation
Control | 0..1
Type | CodeableConcept
56. MajorSurgery.prothesis
Definition | Prothesis
Short | Prothesis
Control | 0..1
Type | BackboneElement
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
58. MajorSurgery.prothesis.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
60. MajorSurgery.prothesis.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `MajorSurgery.prothesis.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
62. MajorSurgery.prothesis.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
64. MajorSurgery.prothesis.status
Definition | Please state if the survivor has a prosthesis either internal (e.g. hip replacement) or external (e.g. artificial arm)
Short | status
Control | 0..1
Type | CodeableConcept
66. MajorSurgery.prothesis.deviceType
Definition | Please define if prosthesis is internal (e.g. titanium bone) or external (e.g. artificial limb). Also in this case, details should be reported in the surgery description. 1 => Internal 2 => External -9922 => NK
Short | device type
Control | 0..1
Type | CodeableConcept
68. MajorSurgery.colostomy
Definition | Colostomy
Short | Colostomy
Control | 0..1
Type | BackboneElement
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
70. MajorSurgery.colostomy.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
72. MajorSurgery.colostomy.extension
Definition | May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `MajorSurgery.colostomy.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
74. MajorSurgery.colostomy.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
76. MajorSurgery.colostomy.status
Definition | State if a colostomy was created. Details should be reported in the surgery section.
Short | status
Control | 0..1
Type | CodeableConcept
78. MajorSurgery.colostomy.isRemoved
Definition | State if a colostomy was created. Details should be reported in the surgery section. 1 => Still in place 2 => Removed -9922 =>NK
Short | In place or removed ?
Control | 0..1
Type | CodeableConcept
80. MajorSurgery.gastrostomy
Definition | State if a gastrostomy was created. Details should be reported in the surgery section. 1 => Yes 2 => No -9911 => Not applicable -9922 =>NK
Short | Gastrostomy
Control | 0..1
Type | CodeableConcept