Analytic Interoperability Framework for High-Fidelity Representation of Perioperative Electronic Health Record Data in the OMOP Common Data Model Using Clinical Representation and Analytic Concept Reconstruction

Objective To evaluate whether complex perioperative electronic health record (EHR) data can be represented within the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) while preserving clinically meaningful analytic concepts. Materials and Methods Data from 31,158 consecutive adult elective surgical encounters (October 2015 - September 2025) were extracted from an academic medical center Epic Clarity database. Source concepts required for a postoperative respiratory failure dataset were manually mapped to OMOP using the OHDSI Athena vocabulary and classified by Health Level 7 equivalence categories under strict and lenient criteria. SQL-based workflows reconstructed clinical representations and analytic concepts, which were validated against the native Epic implementation. Results The reference dataset comprised 28 analytic variables derived from 538 source concepts. Under strict criteria, 40.7% of mappings were equal; under lenient criteria permitting clinical equivalence despite terminology or granularity differences, 97.4% were classified as equal. OMOP achieved >99% cohort concordance. Among 31,083 shared encounters, reconstructed analytic variables showed high agreement, with meaningful differences primarily involving vasopressor infusion identification, body mass index selection, and payer assignment; admission source accounted for most discordant cohort assignments. Discussion Concept equivalence alone incompletely characterized analytic interoperability. Reconstruction of clinical representations and analytic concepts from standardized OMOP concepts preserved analytic fidelity despite incomplete exact concept matching. Conclusions Complex perioperative EHR data can be represented within OMOP with high implementation fidelity despite imperfect concept equivalence. Evaluating preservation of clinically meaningful analytic concepts, rather than vocabulary equivalence alone, provides a practical framework for interoperable perioperative research.