Supplemental Digital Content
SDC Table 1 Multivariable Association of Top Eight Risk Factors with 30-day Mortality (n=2,275,240)
Characteristics1,2 OR (95% CI) P value
1. Age (years) 1.042 (1.041-1.043) <.0001
2. ASA Class
II. A patient with mild systemic disease vs. I. A normal healthy patient 2.777 (2.109-3.656)
<.0001 III. A patient with severe systemic disease vs. I. A normal healthy patient 12.210 (9.329-16.058)
IV. A patient with severe systemic disease that is a constant threat to life vs. I. A normal healthy patient 37.672 (28.696-49.456) V. A moribund patient who is not expected to survive vs. I. A normal healthy patient 121.829 (92.223-160.940)
3. Emergency operation 2.006 (1.947-2.066) <.0001
4. Functional health status prior to surgery
<.0001
Partially Dependent vs. Independent 2.315 (2.240-2.391)
Totally Dependent vs. Independent 3.648 (3.509-3.793)
5. Inpatient/Outpatient
Inpatient vs. Outpatient 4.190 (3.880-4.525) <.0001
6. Systemic sepsis (within 48 hour)
Other vs. None 1.094 (0.899-1.332)
SIRS vs. None 2.303 (2.218-2.390) <.0001
Sepsis vs. None 2.443 (2.338-2.553)
Septic Shock vs. None 4.127 (3.926-4.337)
7. Primary surgeon specialty
Gynecology vs. General surgery 0.497 (0.423-0.585)
Neurosurgery vs. General surgery 0.976 (0.905-1.051)
Orthopedic surgery vs. General surgery 0.579 (0.549-0.611)
Otolaryngology vs. General surgery 0.575 (0.475-0.698) <.0001
Plastic surgery vs. General surgery 0.662 (0.538-0.814)
Thoracic surgery vs. General surgery 1.495 (1.372-1.628)
Urologic surgery vs. General surgery 0.630 (0.570-0.697)
Vascular surgery vs. General surgery 0.853 (0.827-0.881)
8. Work relative value unit 1.020 (1.019-1.021) <.0001
1Abbreviations: ASA class, American Society of Anesthesiology physical status classification; SIRS – Systemic inflammatory response syndrome.
2The intercept was -11.45.
SDC Table 2. Multivariable Association of Top Eight Risk Factors with Overall Morbidity. (n=2,275,240)
Characteristics1,2 OR (95% CI) P value
1. Age (years) 1.011 (1.011-1.011) <.0001
2. ASA Class
II. A patient with mild systemic disease vs. I. A normal healthy patient 1.569 (1.528-1.612)
III. A patient with severe systemic disease vs. I. A normal healthy patient 2.766 (2.693-2.842) <.0001 IV. A patient with severe systemic disease that is a constant threat to life vs. I. A normal healthy patient 5.351 (5.195-5.513)
V. A moribund patient who is not expected to survive vs. I. A normal healthy patient 8.422 (7.835-9.052)
3. Emergency operation 1.557 (1.537-1.578) <.0001
4. Functional health status prior to surgery
Partially Dependent vs. Independent 1.766 (1.737-1.795) <.0001
Totally Dependent vs. Independent 2.405 (2.338-2.474)
5. Inpatient/Outpatient
Inpatient vs. Outpatient 3.757 (3.695-3.820) <.0001
6. Systemic sepsis (within 48 hour)
Other vs. None 1.135 (1.071-1.204)
SIRS vs. None 1.847 (1.815-1.880) <.0001
Sepsis vs. None 2.667 (2.608-2.727)
Septic Shock vs. None 4.400 (4.217-4.591)
7. Primary surgeon specialty
Gynecology vs. General surgery 1.405 (1.374-1.437)
Neurosurgery vs. General surgery 0.701 (0.683-0.720)
Orthopedic surgery vs. General surgery 1.290 (1.272-1.308)
Otolaryngology vs. General surgery 0.790 (0.755-0.827) <.0001
Plastic surgery vs. General surgery 1.318 (1.264-1.373)
Thoracic surgery vs. General surgery 0.912 (0.878-0.947)
Urologic surgery vs. General surgery 0.908 (0.886-0.930)
Vascular surgery vs. General surgery 0.863 (0.852-0.874)
8. Work relative value unit 1.047 (1.047-1.048) <.0001
1Abbreviations: ASA class, American Society of Anesthesiology physical status classification; SIRS – Systemic inflammatory response syndrome.
2The intercept was -5.56.
SDC Table 3. Multivariable Association of Top Eight Risk Factors with Infectious Cluster. (n=2,275,240)
Characteristics1,2 OR (95% CI) P value
1.Age (years) 1.003 (1.003-1.004) <.0001
2. ASA Class
II. A patient with mild systemic disease vs. I. A normal healthy patient 1.547 (1.500-1.595)
III. A patient with severe systemic disease vs. I. A normal healthy patient 2.405 (2.331-2.482) <.0001 IV. A patient with severe systemic disease that is a constant threat to life vs. I. A normal healthy patient 3.014 (2.908-3.123)
V. A moribund patient who is not expected to survive vs. I. A normal healthy patient 2.029 (1.875-2.196)
3. Emergency operation 1.270 (1.249-1.291) <.0001
4. Functional health status prior to surgery
Partially Dependent vs. Independent 1.778 (1.741-1.815) <.0001
Totally Dependent vs. Independent 1.802 (1.743-1.862)
5. Inpatient/Outpatient
Inpatient vs. Outpatient 3.063 (3.005-3.122) <.0001
6. Systemic sepsis (within 48 hour)
Other vs. None 1.008 (0.933-1.089)
SIRS vs. None 1.661 (1.626-2.009) <.0001
Sepsis vs. None 1.957 (1.906-2.009)
Septic Shock vs. None 1.221 (1.167-1.278)
7. Primary surgeon specialty
Gynecology vs. General surgery 1.054 (1.025-1.084)
Neurosurgery vs. General surgery 0.422 (0.406-0.439)
Orthopedic surgery vs. General surgery 0.389 (0.379-0.398)
Otolaryngology vs. General surgery 0.558 (0.525-0.593) <.0001
Plastic surgery vs. General surgery 1.137 (1.083-1.193)
Thoracic surgery vs. General surgery 0.436 (0.411-0.463)
Urologic surgery vs. General surgery 0.657 (0.635-0.679)
Vascular surgery vs. General surgery 0.587 (0.576-0.597)
8. Work relative value unit 1.035 (1.034-1.036) <.0001
1Abbreviations: ASA class, American Society of Anesthesiology physical status classification; SIRS – Systemic inflammatory response syndrome.
2The intercept was -5.00.
SDC Table 4. Multivariable Association of Top Eight Risk Factors with Cardiac/Transfusion Cluster. (n=2,275,240)
Characteristics1,2 OR (95% CI) P value
1. Age (years) 1.017 (1.017-1.018) <.0001
2. ASA Class*
II. A patient with mild systemic disease vs. I. A normal healthy patient 1.868 (1.759-1.984)
III. A patient with severe systemic disease vs. I. A normal healthy patient 3.822 (3.599-4.059) <.0001 IV. A patient with severe systemic disease that is a constant threat to life vs. I. A normal healthy patient 8.165 (7.674-8.688)
3. Emergency operation 1.582 (1.551-1.614) <.0001
4. Functional health status prior to surgery
Partially Dependent vs. Independent 1.261 (1.232-1.290) <.0001
Totally Dependent vs. Independent 1.138 (1.098-1.179)
5. Inpatient/Outpatient
Inpatient vs. Outpatient 12.211 (11.603-12.851) <.0001
6. Systemic sepsis (within 48 hour)
Other vs. None 1.451 (1.335-1.577)
SIRS vs. None 1.614 (1.571-1.659) <.0001
Sepsis vs. None 2.316 (2.245-2.390)
Septic Shock vs. None 2.964 (2.837-3.096)
7. Primary surgeon specialty
Gynecology vs. General surgery 3.055 (2.951-3.162)
Neurosurgery vs. General surgery 1.288 (1.240-1.338)
Orthopedic surgery vs. General surgery 4.550 (4.467-4.634)
Otolaryngology vs. General surgery 1.475 (1.372-1.585) <.0001
Plastic surgery vs. General surgery 2.233 (2.082-2.396)
Thoracic surgery vs. General surgery 1.395 (1.322-1.472)
Urologic surgery vs. General surgery 1.925 (1.860-1.992)
Vascular surgery vs. General surgery 1.641 (1.611-1.672)
8. Work relative value unit 1.055 (1.054-1.056) <.0001
1Abbreviations: ASA class, American Society of Anesthesiology physical status classification; SIRS – Systemic inflammatory response syndrome.
2The intercept was -9.10.
*ASA IV and ASA V combined due to small volume of ASA V patients.
SDC Table 5. Multivariable Association of Top Eight Risk Factors with Pulmonary Cluster. (n=2,275,240)
Characteristics1,2 OR (95% CI) P value
1. Age (years) 1.016 (1.015-1.016) <.0001
2. ASA Class
II. A patient with mild systemic disease vs. I. A normal healthy patient 2.618 (2.372-2.890)
III. A patient with severe systemic disease vs. I. A normal healthy patient 7.886 (7.151-8.697) <.0001 IV. A patient with severe systemic disease that is a constant threat to life vs. I. A normal healthy patient 19.743 (17.881-21.800)
V. A moribund patient who is not expected to survive vs. I. A normal healthy patient 20.853 (18.563-23.425)
3. Emergency operation 1.934 (1.894-1.975) <.0001
4. Functional health status prior to surgery
Partially Dependent vs. Independent 1.927 (1.880-1.975) <.0001
Totally Dependent vs. Independent 3.289 (3.184-3.398)
5. Inpatient/Outpatient
Inpatient vs. Outpatient 6.012 (5.715-6.325) <.0001
6. Systemic sepsis (within 48 hour)
Other vs. None 0.899 (0.788-1.026)
SIRS vs. None 2.413 (2.350-2.477) <.0001
Sepsis vs. None 3.257 (3.160-3.356)
Septic Shock vs. None 6.275 (6.015-6.547)
7. Primary surgeon specialty
Gynecology vs. General surgery 0.492 (0.454-0.533)
Neurosurgery vs. General surgery 0.704 (0.670-0.740)
Orthopedic surgery vs. General surgery 0.332 (0.318-0.347)
Otolaryngology vs. General surgery 1.139 (1.049-1.236) <.0001
Plastic surgery vs. General surgery 0.578 (0.511-0.654)
Thoracic surgery vs. General surgery 1.620 (1.538-1.707)
Urologic surgery vs. General surgery 0.499 (0.468-0.531)
Vascular surgery vs. General surgery 0.703 (0.688-0.719)
8. Work relative value unit 1.041 (1.040-1.042) <.0001
1Abbreviations: ASA class, American Society of Anesthesiology physical status classification; SIRS – Systemic inflammatory response syndrome.
2The intercept was -8.85.
SDC Table 6. Multivariable Association of Top Eight Risk Factors with Venous Thromboembolic Cluster. (n=2,275,240)
Characteristics1,2 OR (95% CI) P value
1. Age (years) 1.013 (1.012-1.014) <.0001
2. ASA Class
II. A patient with mild systemic disease vs. I. A normal healthy patient 1.685 (1.521-1.866)
III. A patient with severe systemic disease vs. I. A normal healthy patient 2.652 (2.393-2.939) <.0001 IV. A patient with severe systemic disease that is a constant threat to life vs. I. A normal healthy patient 3.724 (3.339-4.153)
V. A moribund patient who is not expected to survive vs. I. A normal healthy patient 2.747 (2.315-3.260)
3. Emergency operation 1.279 (1.228-1.332) <.0001
4. Functional health status prior to surgery
Partially Dependent vs. Independent 1.499 (1.429-1.573) <.0001
Totally Dependent vs. Independent 1.696 (1.586-1.814)
5. Inpatient/Outpatient
Inpatient vs. Outpatient 3.358 (3.168-3.559) <.0001
6. Systemic sepsis (within 48 hour)
Other vs. None 0.953 (0.771-1.177)
SIRS vs. None 1.820 (1.729-1.916) <.0001
Sepsis vs. None 2.206 (2.077-2.344)
Septic Shock vs. None 2.242 (2.059-2.442)
7. Primary surgeon specialty
Gynecology vs. General surgery 0.882 (0.805-0.967)
Neurosurgery vs. General surgery 1.332 (1.245-1.425)
Orthopedic surgery vs. General surgery 1.073 (1.024-1.125)
Otolaryngology vs. General surgery 0.571 (0.475-0.686) <.0001
Plastic surgery vs. General surgery 0.917 (0.782-1.075)
Thoracic surgery vs. General surgery 1.224 (1.104-1.359)
Urologic surgery vs. General surgery 0.920 (0.848-0.997)
Vascular surgery vs. General surgery 0.702 (0.672-0.733)
8. Work relative value unit 1.035 (1.033-1.036) <.0001
1Abbreviations: ASA class, American Society of Anesthesiology physical status classification; SIRS – Systemic inflammatory response syndrome.
2The intercept was -8.07.
SDC Table 7. Multivariable Association of Top Eight Risk Factors with Renal Cluster. (n=2,275,240)
Characteristics1,2 OR (95% CI) P value
1. Age (years) 1.012 (1.012-1.013) <.0001
2. ASA Class
II. A patient with mild systemic disease vs. I. A normal healthy patient 3.631 (2.826-4.666)
III. A patient with severe systemic disease vs. I. A normal healthy patient 11.737 (9.153-15.050) <.0001 IV. A patient with severe systemic disease that is a constant threat to life vs. I. A normal healthy patient 24.920 (19.395-32.018)
V. A moribund patient who is not expected to survive vs. I. A normal healthy patient 38.243 (29.380-49.780)
3. Emergency operation 1.646 (1.577-1.717) <.0001
4. Functional health status prior to surgery
Partially Dependent vs. Independent 1.378 (1.311-1.449) <.0001
Totally Dependent vs. Independent 1.577 (1.483-1.677)
5.Inpatient/Outpatient
Inpatient vs. Outpatient 5.832 (5.267-6.459) <.0001
6. Systemic sepsis (within 48 hour)
Other vs. None 1.012 (0.790-1.298)
SIRS vs. None 1.855 (1.757-1.959) <.0001
Sepsis vs. None 2.300 (2.163-2.445)
Septic Shock vs. None 3.106 (2.889-3.339)
7. Primary surgeon specialty
Gynecology vs. General surgery 0.484 (0.408-0.574)
Neurosurgery vs. General surgery 0.264 (0.225-0.311)
Orthopedic surgery vs. General surgery 0.426 (0.391-0.464)
Otolaryngology vs. General surgery 0.330 (0.243-0.449) <.0001
Plastic surgery vs. General surgery 0.625 (0.482-0.810)
Thoracic surgery vs. General surgery 0.918 (0.806-1.045)
Urologic surgery vs. General surgery 1.360 (1.247-1.483)
Vascular surgery vs. General surgery 1.102 (1.059-1.148)
8. Work relative value unit 1.034 (1.033-1.036) <.0001
1Abbreviations: ASA class, American Society of Anesthesiology physical status classification; SIRS – Systemic inflammatory response syndrome.
2The intercept was -10.33.
SDC Table 8. Multivariable Association of Top Eight Risk Factors with Neurological Cluster. (n=2,275,240)
Characteristics1,2 OR (95% CI) P value
1. Age (years) 1.032 (1.029-1.034) <.0001
2. ASA Class
II. A patient with mild systemic disease vs. I. A normal healthy patient 2.878 (1.839-4.505)
III. A patient with severe systemic disease vs. I. A normal healthy patient 7.600 (4.871-11.857) <.0001 IV. A patient with severe systemic disease that is a constant threat to life vs. I. A normal healthy patient 11.481 (7.330-17.983)
V. A moribund patient who is not expected to survive vs. I. A normal healthy patient 9.167 (5.605-14.993)
3. Emergency operation 1.602 (1.485-1.728) <.0001
4. Functional health status prior to surgery
Partially Dependent vs. Independent 1.397 (1.283-1.521) <.0001
Totally Dependent vs. Independent 1.856 (1.656-2.081)
5. Inpatient/Outpatient
Inpatient vs. Outpatient 3.097 (2.699-3.554) <.0001
6. Systemic sepsis (within 48 hour)
Other vs. None 1.226 (0.854-1.759)
SIRS vs. None 1.410 (1.273-1.561) <.0001
Sepsis vs. None 1.173 (1.018-1.352)
Septic Shock vs. None 1.959 (1.682-2.282)
7. Primary surgeon specialty
Gynecology vs. General surgery 0.555 (0.400-0.769)
Neurosurgery vs. General surgery 3.385 (3.022-3.791)
Orthopedic surgery vs. General surgery 0.806 (0.712-0.912)
Otolaryngology vs. General surgery 1.212 (0.874-1.680) <.0001
Plastic surgery vs. General surgery 0.962 (0.625-1.482)
Thoracic surgery vs. General surgery 1.465 (1.166-1.840)
Urologic surgery vs. General surgery 1.124 (0.937-1.349)
Vascular surgery vs. General surgery 2.742 (2.567-2.929)
8. Work relative value unit 1.026 (1.023-1.028) <.0001
1Abbreviations: ASA class, American Society of Anesthesiology physical status classification; SIRS – Systemic inflammatory response syndrome.
2The intercept was -11.77.
SDC Table 9. Comparison of the Brier Scores for the Eight Variable Model with the Full Models COMPLICATION CLUSTERS
Comparison Mortality
Overall
Morbidity Infectious
Cardiac/
Transfusion
Pulmonar
y VTE* Renal Neurological 8-Variable Model Brier Score
0.0115 0.0918 0.0577 0.0422 0.0258 0.0089
0.006 7
0.0022 Full Model Brier Score
0.0112 0.0902 0.0575 0.0394 0.0254 0.0089
0.006 7
0.0023 Difference
0.0003 0.0016 0.0002 0.0028 0.0004 0.0000
0.000 0
0.0001
*VTE, venous thromboembolic
SDC Table 10. Summary of Patient Risk Factor Rankings for the Eight full Bootstrapped logistic regression models (n=2,275,240)
Characteristics1,2
30-day Mortality
30-day
Morbidity Infectious
Cardiac/
Transfusion Pulmonary VTE* Renal Neurological
Average Rank
ASA Class 1.0 3.0 4.0 4.0 1.6 3.6 1.3 2.7 2.7
Work relative value unit 9.4 1.0 1.0 2.0 1.4 1.0 1.7 4.1 2.7
Inpatient/Outpatient 7.5 2.0 2.0 5.0 4.0 2.0 3.6 4.9 3.9
Primary surgeon specialty 13.3 5.0 3.0 1.0 5.0 6.7 6.9 1.0 5.2
Systemic sepsis (within 48 hours) 4.1 4.0 6.0 8.4 3.0 4.0 7.5 11.5 6.1
Age (years) 2.0 7.1 13.3 6.0 7.0 4.4 10.1 2.3 6.5
Emergency operation 5.8 7.9 8.0 10.1 6.0 13.6 9.1 7.2 8.5
Functional health status prior to surgery 5.2 10.2 7.0 16.7 8.9 10.7 17.9 7.7 10.5
Body mass index category (kg/m2) 9.4 15.9 11.3 7.3 16.6 11.1 13.1 9.9 11.8
Transfer status 14.1 10.8 17.1 8.3 13.3 11.2 15.1 15.1 13.1
Disseminated cancer 3.0 13.6 14.5 11.6 24.2 8.0 22.5 24.2 15.2
Transfusion of pack red blood cells (within 72 hours) 18.6 6.0 20.3 3.0 19.0 17.4 18.9 23.2 15.8
Steroid use for chronic condition 16.9 13.4 9.1 20.2 18.0 6.9 20.8 25.6 16.4
Open wound with or without infection 25.8 9.0 5.0 12.3 21.0 21.8 25.8 11.0 16.5
>10% loss of body weight (within 6 months) 12.1 15.0 11.8 16.0 16.8 13.2 23.4 23.9 16.5
Ventilator dependent (within 48 hours) 16.0 12.2 23.8 22.9 8.1 21.1 19.0 11.9 16.9
Race/Ethnicity 26.2 22.1 17.0 13.9 20.7 9.2 12.3 18.6 17.5
Ascites (within 30 days) 7.8 17.8 20.4 19.8 14.7 21.9 13.8 25.2 17.7
Gender 22.3 27.8 24.6 16.3 13.7 14.8 6.5 16.1 17.8
Cigarette smoker (within 1 year) 25.3 19.2 9.9 26.1 11.2 18.6 26.3 12.6 18.6
Diabetes mellitus 24.7 21.1 14.1 16.9 27.3 17.1 15.6 14.9 19.0
Bleeding disorder requiring hospitalization 19.5 17.2 18.7 12.1 25.7 22.8 26.2 13.9 19.5
Acute renal failure (rising creatinine to >3 mg/dl within 24 hours) 21.8 22.8 22.1 22.0 21.3 26.9 3.5 18.6 19.9
Dyspnea (within 30 days) 14.6 24.0 26.1 27.4 12.1 18.3 20.0 21.0 20.4
Dialysis or hemofiltration (within 2 weeks) 11.0 27.2 25.7 20.2 27.5 25.2 5.0 23.1 20.6
Blood pressure >140/90 mm Hg or taking antihypertensive
medications 28.0 26.0 26.8 24.0 23.9 21.0 11.2 7.3 21.0
Severe chronic obstructive pulmonary disease (COPD) 19.9 19.7 17.6 26.1 10.0 27.0 27.5 24.3 21.5
Congestive heart failure (within 30 days) 20.9 25.0 25.9 26.3 24.0 26.7 21.5 24.1 24.3
1Abbreviations: ASA class, American Society of Anesthesiology physical status classification; PRBCs, packed red blood cells; VTE, venous thromboembolic.
