Supplementary Methods - Lippincott Williams & Wilkins



A Population-Based Analysis of Intraoperative Cardiac Arrest in the United StatesAppendix – Supplementary Statistical Methods and ResultsVikram Fielding-Singh, MD, JD,1 Mark D. Willingham, MD, MS,2 Matthew A. Fischer, MD, MS,1 Tristan Grogan, MS,3 Peyman Benharash, MD,4 Jacques P. Neelankavil, MD11 Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; 2 Division of Cardiothoracic Anesthesiology and Perioperative Medicine, Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri; 3 Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; 4 Cardiovascular Outcomes Research Laboratories, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CaliforniaTable of Contents TOC \o "1-2" \h \z \u Supplementary Methods PAGEREF _Toc13559771 \h 3Supplementary Table 1. Identification of Surgical Subtypes for Multivariable Models PAGEREF _Toc13559772 \h 3Supplementary Table 2. Identification of Elixhauser Comorbidities for Multivariable Models PAGEREF _Toc13559773 \h 4Supplementary Table 3. Identification of Variables for Exploratory Analyses PAGEREF _Toc13559774 \h 5Supplementary Results PAGEREF _Toc13559775 \h 6Supplementary Figure. Selection of Subpopulations for Analysis of Intraoperative Cardiac Arrest PAGEREF _Toc13559776 \h 6Supplementary Table 4. Incidence and 95% Confidence Interval of Intraoperative Cardiac Arrest per 10,000 Hospital Admissions Involving Operating Room Procedures by All Patient and Admission Characteristics PAGEREF _Toc13559777 \h 7Supplementary Table 5. Adjusted Odds Ratios for In-Hospital Mortality, Full Model PAGEREF _Toc13559778 \h 9Supplementary Table 6. Linear Regression Coefficients for Length of Stay, Full Model PAGEREF _Toc13559779 \h 11Supplementary Table 7. Linear Regression Coefficients for Total Admission Costs, Full Model PAGEREF _Toc13559780 \h 13Supplementary Table 8. Baseline Patient and Admission Characteristics Before and After Propensity Score Matching PAGEREF _Toc13559781 \h 15Supplementary Table 9. Effect Estimates for Secondary Outcomes from Linear and Logistic Regression Models in the Propensity Score Matched Cohort PAGEREF _Toc13559782 \h 18Supplementary Table 10. Adjusted Odds Ratios for Intraoperative Cardiac Arrest, Full Model PAGEREF _Toc13559783 \h 19Supplementary Table 11. Adjusted Odds Ratios for Intraoperative Cardiac Arrest, Subgroup Analyses PAGEREF _Toc13559784 \h 21Supplementary Table 12. Adjusted Odds Ratios for Intraoperative Cardiac Arrest, Elective Admissions with Procedures on Day 0 PAGEREF _Toc13559785 \h 24Supplementary Table 13. Adjusted Odds Ratios for Intraoperative Cardiac Arrest, Exploratory Analysis, Selected Covarariates PAGEREF _Toc13559786 \h 26Supplementary Table 14. Adjusted Odds Ratios for Mortality During Admissions with Intraoperative Cardiac Arrest, Full Model PAGEREF _Toc13559787 \h 27References PAGEREF _Toc13559788 \h 29Supplementary MethodsSupplementary Table 1. Identification of Surgical Subtypes for Multivariable ModelsSurgical subtypeMulti-level CCS Procedure CategoryICD-10-CMCardiac7.1-7.9Endocrine2Intraabdominal general8.3, 9Genitourinary10 (excluding 10.4), 11Gynecologic12Heart and lung transplant02YA0Z0, 02YA0Z1, 02YA0Z2, 0BYC0Z0, 0BYC0Z1, 0BYC0Z2, 0BYD0Z0, 0BYD0Z1, 0BYD0Z2, 0BYF0Z0, 0BYF0Z1, 0BYF0Z2, 0BYG0Z0, 0BYG0Z1, 0BYG0Z2, 0BYH0Z0, 0BYH0Z1, 0BYH0Z2, 0BYJ0Z0, 0BYJ0Z1, 0BYJ0Z2, 0BYK0Z0, 0BYK0Z1, 0BYK0Z2, 0BYL0Z0, 0BYL0Z1, 0BYL0Z2, 0BYM0Z0, 0BYM0Z1, 0BYM0Z2Neurosurgery1Noncardiac transplant10.407YM0Z0, 07YM0Z1, 07YM0Z2, 07YP0Z0, 07YP0Z1, 07YP0Z2, 0DY50Z0, 0DY50Z1, 0DY50Z2, 0DY60Z0, 0DY60Z1, 0DY60Z2, 0DY80Z0, 0DY80Z1, 0DY80Z2, 0DYE0Z0, 0DYE0Z1, 0DYE0Z2, 0FY00Z0, 0FY00Z1, 0FY00Z2, 0FYG0Z0, 0FYG0Z1, 0FYG0Z2, 0UY00Z0, 0UY00Z1, 0UY00Z2, 0UY10Z0, 0UY10Z1, 0UY10Z2, 0WY20Z0, 0WY20Z1, 0XYJ0Z0, 0XYJ0Z1, 0XYK0Z0, 0XYK0Z1, 3E030U0, 3E030U1, 3E033U0, 3E033U1, 3E0J3U0, 3E0J3U1, 3E0J7U0, 3E0J7U1, 3E0J8U0, 3E0J8U1Obstetrics13Ophthalmologic3Orthopedic14Otolaryngology4, 5Skin and subcutaneous tissue15Thoracic6Vascular7.10-7.19* The Healthcare Cost and Utilization Project’s Clinical Classifications Software ADDIN EN.CITE <EndNote><Cite><RecNum>539</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>539</rec-number><foreign-keys><key app="EN" db-id="vw2fv5vdmzzaased9t5xt0skze5fs9ttxes9" timestamp="1541435403">539</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors></contributors><titles><title>Beta Clinical Classifications Software (CCS) for ICD-10-CM/PCS. Healthcare Cost and Utilization Project (HCUP). October 2018. Agency for Healthcare Research and Quality, Rockville, MD.</title></titles><number>November 5, 2018</number><dates></dates><urls><related-urls><url> was used to categorize surgical subtype when appropriate. When the Clinical Classifications Software category contained procedures performed by different surgical specialties or procedures likely to have significantly different rate of intraoperative cardiac arrest, individual ICD-10-PCS codes were used to assign surgical subtypes. For example, heart and lung transplantation was separated from other transplantation procedures using individual ICD-10-PCS codes.Supplementary Table 2. Identification of Elixhauser Comorbidities for Multivariable ModelsComorbidityAHRQ Comorbidity VariableHypertensionHTN_CDiabetes mellitus without complicationsDMDiabetes mellitus with complicationsDMCXEnd-stage renal diseaseRENLFAILValvular heart diseaseVALVECongestive heart failureCHFPulmonary circulation disordersPULMCIRCPeripheral vascular diseasePERIVASCChronic lung diseaseCHRNLUNGLiver diseaseLIVERObesityOBESEAlcohol use disorderALCOHOLDrug abuseDRUGParalysisPARAOther neurologic disordersNEUROHypothyroidismHYPOTHYChronic peptic ulcer diseaseULCERHIV or AIDSAIDSLymphomaLYMPHMetastatic tumorMETSSolid tumor without metastasesTUMORRA / collagen vascular diseaseARTHCoagulation deficiencyCOAGWeight lossWGHTLOSSFluid and electrolyte disordersLYTESBlood loss anemiaBLDLOSSDeficiency anemiasANEMDEFPsychosesPSYCHDepressionDEPRESSAHRQ = Agency for Healthcare Research and Quality; AIDS = acquired immune deficiency syndrome; HIV = human immunodeficiency virus; RA = rheumatoid arthritis.Supplementary Table 3. Identification of Variables for Exploratory AnalysesComorbiditySingle-level CCS Diagnosis CategoryMulti-level CCS Diagnosis CategorySingle-level CCS Procedure CategoryICD-10 CodeCoronary artery disease101Prior coronary revascularizationZ951, Z955, Z9861Tracheal or laryngeal surgery33, 34, 35Venous thromboembolismZ86711, I82501, I82502, I82503, I82509, I82511, I82512, I82513, I82519, I82521, I82522, I82523, I82529, I82531, I82532, I82533, I82539, I82541, I82542, I82543, I82549, I82591, I82592, I82593, I82599, I825Y1, I825Y2, I825Y3, I825Y9, I825Z1, I825Z2, I825Z3, I825Z9, I82701, I82702, I82703, I82709, I82711, I82712, I82713, I82719, I82721, I82722, I82723, I82729, I82891, I8291, I82A21, I82A22, I82A23, I82A29, I82B21, I82B22, I82B23, I82B29, I82C21, I82C22, I82C23, I82C29, I87001, I87002, I87003, I87009, I87011, I87012, I87013, I87019, I87021, I87022, I87023, I87029, I87031, I87032, I87033, I87039, I87091, I87092, I87093, I87099, Z86718, Z8672Active smokerO99330, O99331, O99332, O99333, O99334, O99335, Z716, Z720, F17200, F17201, F17203, F17208, F17209, F17210, F17213, F17218, F17219History of stroke7.3CCS = Clinical Classifications Software; ICD = International Classification of Disease.Supplementary ResultsSupplementary Figure. Selection of Subpopulations for Analysis of Intraoperative Cardiac Arrest291053655689526,032,596Admissions excluded*25,688,126 No operating room procedure5,479,699 Age under 18 years26,032,596Admissions excluded*25,688,126 No operating room procedure5,479,699 Age under 18 years29025851777448397,964Admissions with missing data397,964Admissions with missing data0317535,675,421Admissions in the National Inpatient Sample in 201635,675,421Admissions in the National Inpatient Sample in 20161385570347980011163309,642,825Admissions for patients 18 years or older who underwent operative room procedures9,642,825Admissions for patients 18 years or older who underwent operative room procedures138557078295503405505Subgroup Analyses7,316,498Admissions without obstetric procedures8,158,472Admissions without cardiac procedures3,287,951Elective admissions with a procedure on day 020,270Admissions matched using propensity scores5,230Admissions involving intraoperative cardiac arrestSubgroup Analyses7,316,498Admissions without obstetric procedures8,158,472Admissions without cardiac procedures3,287,951Elective admissions with a procedure on day 020,270Admissions matched using propensity scores5,230Admissions involving intraoperative cardiac arrest1385570281940002222500Primary Analysis9,244,861Admissions for patients 18 years or older who underwent operative room procedures with complete dataPrimary Analysis9,244,861Admissions for patients 18 years or older who underwent operative room procedures with complete data1385570145478513855701888490Confidence intervals excluded for observation estimates.* Observation subtotals are not mutually exclusive.Supplementary Table 4. Incidence and 95% Confidence Interval of Intraoperative Cardiac Arrest per 10,000 Hospital Admissions Involving Operating Room Procedures by All Patient and Admission CharacteristicsCharacteristicNumber of Admissions(n = 9,244,861)Number of Intraoperative Cardiac Arrests(n = 5,230)Incidence per 10,000 Admissions(95% CI)Age, years18-392,700,1183501.3 (1-1.7)40-592,288,5941,1805.2 (4.5-5.9)60-793,357,1742,7158.1 (7.4-8.8)80+898,97598511 (9.4-12.7)Sex??Male3,528,3393,1208.8 (8.1-9.6)Female5,716,5222,1103.7 (3.3-4.1)Race??White6,155,7563,5005.7 (5.2-6.2)Black1,058,2257507.1 (6-8.4)Hispanic972,6103303.4 (2.6-4.4)Asian or Pacific Islander275,2051706.2 (4.4-8.6)Native American46,955408.5 (4.3-16.9)Other281,0101154.1 (2.7-6.3)Missing455,1013257.1 (5.6-9.1)Payor status??Medicare3,578,7893,2559.1 (8.4-9.9)Medicaid1,572,1794352.8 (2.2-3.5)Private3,486,6941,3103.8 (3.3-4.3)Self-pay275,8851053.8 (2.5-5.8)No charge23,915208.4 (3.1-22.4)Other307,4001053.4 (2.2-5.3)Hospital ownershipPrivate non-profit 6,892,9973,9505.7 (5.3-6.2)Government, nonfederal1,002,8707307.3 (6-8.8)Private invest-own1,348,9945504.1 (3.3-5)Patient county size??Central metro > 1M2,620,2531,4855.7 (5-6.4)Fringe metro > 1M2,291,6241,1955.2 (4.5-6)250K-1M1,961,1691,0605.4 (4.7-6.2)50-250K865,9045406.2 (5.1-7.6)Micropolitan857,6255306.2 (5.1-7.4)Other648,2854206.5 (5.2-8.1)Median zip code income percentile??0-25th2,523,0081,5056 (5.3-6.8)26th-50th 2,351,3041,3305.7 (5-6.4)51th-75th2,322,3551,3105.6 (4.9-6.4)76th-100th2,048,1941,0855.3 (4.6-6.1)Census Division??New England418,4952405.7 (3.8-8.7)Mid Atlantic1,278,6857505.9 (4.8-7.1)East North Central1,386,4798606.2 (5.2-7.3)West North Central673,4003955.9 (4.6-7.4)South Atlantic1,897,8551,0405.5 (4.8-6.2)East South Central641,8333705.8 (4.4-7.6)West South Central1,133,7565655 (4.1-6)Mountain621,2483405.5 (4.2-7.2)Pacific1,193,1106705.6 (4.6-6.9)Hospital location??Rural620,2252704.4 (3.3-5.8)Urban nonteaching2,245,9029104.1 (3.5-4.7)Urban teaching6,378,7344,0506.3 (5.9-6.9)Type of hospitalization??Non-elective4,462,3173,3957.6 (7-8.3)Elective4,782,5441,8353.8 (3.4-4.3)Month of admission??January750,6404706.3 (5.1-7.7)February747,0504055.4 (4.4-6.7)March786,5055056.4 (5.2-7.9)April753,3754455.9 (4.7-7.4)May773,7804555.9 (4.8-7.3)June783,6453905 (4-6.2)July748,2604255.7 (4.6-7)August812,4754956.1 (5-7.4)September762,5553604.7 (3.7-6)October782,2154155.3 (4.3-6.6)November772,6853754.9 (3.9-6.1)December771,6804906.3 (5.2-7.8)Admission day??Weekday8,006,7024,3655.5 (5.1-5.9)Weekend1,238,1598657 (6-8.2)Procedural risk??Low5,515,9534800.9 (0.7-1.1)High3,728,9084,75012.7 (11.9-13.6)ComorbiditiesCongestive heart failure437,25079518.2 (15.5-21.3)Valvular disease249,15025010 (7.5-13.4)Pulmonary circulation disorders49,52516032.3 (22.8-45.8)Peripheral vascular disease560,2601,07019.1 (16.6-22)Hypertension4,325,7793,3357.7 (7.1-8.4)Paralysis212,57527012.7 (9.7-16.6)Other neurological disorders489,5304108.4 (6.8-10.4)Chronic pulmonary disease1,404,4841,0607.5 (6.6-8.6)Diabetes without chronic complications1,083,4458357.7 (6.7-8.9)Diabetes with chronic complications828,41095511.5 (9.9-13.4)Hypothyroidism995,7455905.9 (4.9-7.1)Renal failure867,3751,52517.6 (15.6-19.8)Liver disease252,01528011.1 (8.5-14.5)Chronic peptic ulcer disease62,0459515.3 (9.8-23.9)HIV and AIDS10,89554.6 (0.6-32.6)Lymphoma36,445308.2 (3.7-18.2)Metastatic cancer194,1751357 (4.7-10.3)Solid tumor without metastasis139,14517012.2 (8.8-16.9)RA / collagen vascular diseases242,1501004.1 (2.6-6.5)Coagulation deficiency437,3401,18027 (23.6-30.9)Obesity1,533,4401,0656.9 (6-8)Weight loss348,30549514.2 (11.7-17.2)Fluid and electrolyte disorders1,445,6392,48017.2 (15.6-18.8)Blood loss anemia404,425601.5 (0.8-2.6)Deficiency anemias1,237,7591,1159 (7.9-10.3)Alcohol abuse224,1801456.5 (4.5-9.4)Drug abuse189,400854.5 (2.8-7.2)Psychoses187,305653.5 (1.9-6.2)Depression909,3654605.1 (4.1-6.2)AIDS = acquired immune deficiency syndrome; HIV = human immunodeficiency virus; K = thousand; M = million; RA = rheumatoid arthritis.Supplementary Table 5. Adjusted Odds Ratios for In-Hospital Mortality, Full ModelCharacteristicOdds Ratio (95% CI)P valueIntraoperative cardiac arrestNo1 [Reference]Yes15.44 (12.74-18.7)< 0.001Age, years18-391 [Reference]40-591.37 (1.29-1.46)< 0.00160-791.98 (1.85-2.12)< 0.00180+3.4 (3.15-3.67)< 0.001SexMale1 [Reference]Female1 (0.97-1.03)0.856RaceWhite1 [Reference]Black0.93 (0.89-0.98)0.01Hispanic0.92 (0.87-0.98)0.006Asian or Pacific Islander1.03 (0.93-1.13)0.606Native American1.18 (0.99-1.42)0.072Other1.1 (1.01-1.2)0.034Missing1.34 (1.21-1.49)< 0.001Payor statusMedicare1 [Reference]Medicaid1 (0.94-1.06)0.976Private0.82 (0.79-0.86)< 0.001Self-pay1.27 (1.16-1.38)< 0.001No charge0.97 (0.71-1.32)0.837Other1.06 (0.97-1.16)0.181Hospital ownershipPrivate non-profit 1 [Reference]Government, nonfederal1.09 (1.01-1.18)0.033Private invest-own1.02 (0.95-1.09)0.582Patient county sizeCentral metro > 1M1 [Reference]Fringe metro > 1M0.99 (0.94-1.04)0.737250K-1M1.13 (1.07-1.2)< 0.00150-250K1.13 (1.06-1.21)< 0.001Micropolitan1.25 (1.17-1.34)< 0.001Other1.17 (1.09-1.25)< 0.001Median zip code income percentile0-25th1 [Reference]26th-50th 0.94 (0.9-0.97)0.00151th-75th0.93 (0.9-0.98)0.00276th-100th0.88 (0.83-0.93)< 0.001Census DivisionNew England1 [Reference]Mid Atlantic1.06 (0.96-1.17)0.24East North Central0.8 (0.73-0.89)< 0.001West North Central0.86 (0.77-0.98)0.018South Atlantic0.9 (0.81-1)0.046East South Central1.07 (0.94-1.21)0.326West South Central0.97 (0.87-1.08)0.603Mountain0.94 (0.83-1.06)0.292Pacific1.04 (0.94-1.15)0.412Hospital locationRural1 [Reference]Urban nonteaching1.01 (0.92-1.11)0.844Urban teaching1.15 (1.05-1.27)0.003Type of hospitalizationNon-elective1 [Reference]Elective0.29 (0.28-0.3)< 0.001Month of admissionJanuary1 [Reference]February1.02 (0.96-1.09)0.487March1.06 (1-1.13)0.065April0.96 (0.9-1.03)0.235May0.98 (0.92-1.05)0.621June0.95 (0.89-1.02)0.155July0.94 (0.88-1.01)0.083August0.93 (0.87-1)0.038September0.97 (0.91-1.03)0.321October0.92 (0.86-0.98)0.008November0.95 (0.89-1.02)0.158December1.04 (0.97-1.11)0.282Admission dayWeekday1 [Reference]Weekend1.13 (1.09-1.17)< 0.001Number of OR procedures1.06 (1.05-1.07)< 0.001Surgical subtypeCardiac1.63 (1.55-1.7)< 0.001Endocrine0.8 (0.63-1.02)0.07Intraabdominal general1.21 (1.16-1.26)< 0.001Genitourinary0.78 (0.73-0.84)< 0.001Gynecologic0.52 (0.45-0.61)< 0.001Heart and lung transplant0.3 (0.2-0.46)< 0.001Neurosurgery2.31 (2.19-2.44)< 0.001Noncardiac transplant0.11 (0.07-0.18)< 0.001Obstetric0.06 (0.04-0.08)< 0.001Ophthalmologic1.27 (0.93-1.74)0.134Orthopedic0.59 (0.57-0.62)< 0.001Otolaryngology0.84 (0.75-0.95)0.006Skin and subcutaneous tissue0.9 (0.86-0.95)< 0.001Thoracic2.29 (2.2-2.39)< 0.001Vascular3.03 (2.9-3.15)< 0.001ComorbiditiesCongestive heart failure1.84 (1.76-1.92)< 0.001Valvular disease1.09 (1.03-1.16)0.005Pulmonary circulation disorders1.83 (1.68-1.99)< 0.001Peripheral vascular disease1.29 (1.24-1.34)< 0.001Hypertension0.77 (0.74-0.79)< 0.001Paralysis1.6 (1.51-1.69)< 0.001Other neurological disorders1.1 (1.04-1.15)< 0.001Chronic pulmonary disease1.01 (0.97-1.05)0.595Diabetes without chronic complications0.94 (0.9-0.98)0.005Diabetes with chronic complications0.8 (0.77-0.84)< 0.001Hypothyroidism0.83 (0.8-0.87)< 0.001Renal failure1.32 (1.27-1.37)< 0.001Liver disease1.58 (1.49-1.67)< 0.001Chronic peptic ulcer disease1.13 (1.03-1.24)0.008HIV and AIDS1.16 (0.87-1.54)0.314Lymphoma1.54 (1.37-1.73)< 0.001Metastatic cancer2.21 (2.09-2.34)< 0.001Solid tumor without metastasis1.35 (1.26-1.46)< 0.001RA / collagen vascular diseases1.05 (0.97-1.13)0.244Coagulation deficiency2.28 (2.19-2.38)< 0.001Obesity0.86 (0.83-0.9)< 0.001Weight loss1.38 (1.32-1.45)< 0.001Fluid and electrolyte disorders2.95 (2.83-3.07)< 0.001Blood loss anemia0.75 (0.67-0.84)< 0.001Deficiency anemias0.77 (0.74-0.8)< 0.001Alcohol abuse1.05 (0.98-1.12)0.152Drug abuse0.77 (0.7-0.85)< 0.001Psychoses0.89 (0.81-0.98)0.014Depression0.72 (0.69-0.76)< 0.001AIDS = acquired immune deficiency syndrome; HIV = human immunodeficiency virus; K = thousand; M = million; OR = operating room; RA = rheumatoid arthritis.Supplementary Table 6. Linear Regression Coefficients for Length of Stay, Full ModelCharacteristicDays (95% CI)P valueIntraoperative cardiac arrestNo1 [Reference]Yes-0.14 (-1.12-0.83)0.772Age, years18-391 [Reference]40-590.26 (0.22-0.31)< 0.00160-790.53 (0.47-0.6)< 0.00180+0.66 (0.58-0.74)< 0.001SexMale1 [Reference]Female-0.17 (-0.2--0.14)< 0.001RaceWhite1 [Reference]Black0.48 (0.43-0.54)< 0.001Hispanic0.09 (0.03-0.15)0.003Asian or Pacific Islander0.17 (0.06-0.27)0.002Native American0.15 (-0.05-0.35)0.135Other0.26 (0.15-0.37)< 0.001Missing0.24 (0.09-0.38)0.001Payor statusMedicare1 [Reference]Medicaid0.64 (0.57-0.7)< 0.001Private0.09 (0.04-0.14)< 0.001Self-pay0.19 (0.09-0.28)< 0.001No charge0.36 (0.11-0.6)0.005Other0.28 (0.19-0.38)< 0.001Hospital ownershipPrivate non-profit 1 [Reference]Government, nonfederal0.4 (0.25-0.54)< 0.001Private invest-own0.02 (-0.07-0.11)0.697Patient county sizeCentral metro > 1M1 [Reference]Fringe metro > 1M-0.02 (-0.08-0.04)0.508250K-1M-0.03 (-0.11-0.05)0.47450-250K-0.07 (-0.15-0.01)0.078Micropolitan0.01 (-0.08-0.09)0.865Other-0.02 (-0.1-0.07)0.712Median zip code income percentile0-25th1 [Reference]26th-50th -0.08 (-0.12--0.04)< 0.00151th-75th-0.07 (-0.12--0.03)< 0.00176th-100th-0.08 (-0.13--0.03)0.002Census DivisionNew England1 [Reference]Mid Atlantic0.24 (0.09-0.4)0.002East North Central-0.46 (-0.61--0.31)< 0.001West North Central-0.28 (-0.46--0.11)0.001South Atlantic0.08 (-0.08-0.24)0.323East South Central0.13 (-0.12-0.37)0.308West South Central-0.06 (-0.22-0.1)0.453Mountain-0.41 (-0.61--0.22)< 0.001Pacific-0.24 (-0.39--0.08)0.003Hospital locationRural1 [Reference]Urban nonteaching0.07 (-0.03-0.16)0.155Urban teaching0.42 (0.32-0.52)< 0.001Type of hospitalizationNon-elective1 [Reference]Elective-1.42 (-1.47--1.36)< 0.001Month of admissionJanuary1 [Reference]February-0.06 (-0.1--0.02)0.006March-0.11 (-0.15--0.07)< 0.001April-0.14 (-0.18--0.1)< 0.001May-0.17 (-0.21--0.13)< 0.001June-0.15 (-0.19--0.11)< 0.001July-0.18 (-0.22--0.13)< 0.001August-0.21 (-0.25--0.17)< 0.001September-0.19 (-0.23--0.15)< 0.001October-0.21 (-0.25--0.17)< 0.001November-0.17 (-0.22--0.13)< 0.001December-0.21 (-0.25--0.17)< 0.001Admission dayWeekday1 [Reference]Weekend-0.02 (-0.08-0.04)0.508Number of OR procedures0.7 (0.68-0.73)< 0.001Surgical subtypeCardiac1.21 (1.12-1.31)< 0.001Endocrine0.59 (0.42-0.76)< 0.001Intraabdominal general2.15 (2.07-2.22)< 0.001Genitourinary0.94 (0.87-1.01)< 0.001Gynecologic-0.49 (-0.54--0.44)< 0.001Heart and lung transplant20.44 (17.67-23.22)< 0.001Neurosurgery0.95 (0.88-1.02)< 0.001Noncardiac transplant7.09 (5.63-8.54)< 0.001Obstetric1.66 (1.58-1.74)< 0.001Ophthalmologic0.66 (0.27-1.06)0.001Orthopedic1.08 (1.02-1.15)< 0.001Otolaryngology0.67 (0.47-0.87)< 0.001Skin and subcutaneous tissue1.88 (1.8-1.96)< 0.001Thoracic5.59 (5.4-5.77)< 0.001Vascular3.31 (3.22-3.39)< 0.001ComorbiditiesCongestive heart failure1.81 (1.73-1.89)< 0.001Valvular disease0.32 (0.24-0.39)< 0.001Pulmonary circulation disorders4.59 (4.28-4.9)< 0.001Peripheral vascular disease0.05 (-0.01-0.11)0.101Hypertension-0.17 (-0.2--0.14)< 0.001Paralysis3.35 (3.19-3.52)< 0.001Other neurological disorders1.14 (1.06-1.21)< 0.001Chronic pulmonary disease-0.03 (-0.06-0)0.097Diabetes without chronic complications-0.12 (-0.15--0.09)< 0.001Diabetes with chronic complications0.59 (0.53-0.65)< 0.001Hypothyroidism-0.01 (-0.04-0.03)0.698Renal failure0.5 (0.43-0.56)< 0.001Liver disease0 (-0.09-0.1)0.929Chronic peptic ulcer disease1.93 (1.72-2.14)< 0.001HIV and AIDS0.8 (0.35-1.26)0.001Lymphoma1.23 (0.99-1.46)< 0.001Metastatic cancer0.25 (0.14-0.36)< 0.001Solid tumor without metastasis0.26 (0.16-0.37)< 0.001RA / collagen vascular diseases0.15 (0.09-0.21)< 0.001Coagulation deficiency1.85 (1.75-1.95)< 0.001Obesity0.38 (0.35-0.41)< 0.001Weight loss5.56 (5.34-5.77)< 0.001Fluid and electrolyte disorders2.8 (2.72-2.87)< 0.001Blood loss anemia0.22 (0.16-0.27)< 0.001Deficiency anemias0.64 (0.58-0.69)< 0.001Alcohol abuse0.61 (0.51-0.71)< 0.001Drug abuse1.24 (1.13-1.35)< 0.001Psychoses0.99 (0.89-1.1)< 0.001Depression0.25 (0.21-0.29)< 0.001AIDS = acquired immune deficiency syndrome; HIV = human immunodeficiency virus; K = thousand; M = million; OR = operating room; RA = rheumatoid arthritis.Supplementary Table 7. Linear Regression Coefficients for Total Admission Costs, Full ModelCharacteristicDollars (95% CI)P valueIntraoperative cardiac arrestNo1 [Reference]Yes13184 (9600-16769)< 0.001Age, years18-391 [Reference]40-59-34 (-244-177)0.75360-79472 (174-769)0.00280+-645 (-1025--264)0.001SexMale1 [Reference]Female-872 (-974--769)< 0.001RaceWhite1 [Reference]Black1372 (1098-1647)< 0.001Hispanic588 (253-924)0.001Asian or Pacific Islander492 (48-935)0.03Native American848 (-864-2560)0.331Other1869 (1069-2668)< 0.001Missing1457 (804-2111)< 0.001Payor statusMedicare1 [Reference]Medicaid1334 (1121-1547)< 0.001Private386 (230-541)< 0.001Self-pay-760 (-1120--400)< 0.001No charge-1059 (-1997--120)0.027Other1144 (718-1569)< 0.001Hospital ownershipPrivate non-profit 1 [Reference]Government, nonfederal2982 (2042-3922)< 0.001Private invest-own-1647 (-2143--1151)< 0.001Patient county sizeCentral metro > 1M1 [Reference]Fringe metro > 1M-267 (-687-153)0.212250K-1M-760 (-1252--267)0.00250-250K-344 (-858-171)0.191Micropolitan-378 (-893-137)0.15Other261 (-292-813)0.355Median zip code income percentile0-25th1 [Reference]26th-50th 318 (139-497)< 0.00151th-75th879 (652-1105)< 0.00176th-100th1603 (1258-1947)< 0.001Census DivisionNew England1 [Reference]Mid Atlantic-2985 (-4424--1545)< 0.001East North Central-3650 (-4959--2342)< 0.001West North Central-3876 (-5162--2591)< 0.001South Atlantic-3183 (-4478--1888)< 0.001East South Central-5235 (-6837--3633)< 0.001West South Central-3590 (-4934--2247)< 0.001Mountain-2681 (-4009--1353)< 0.001Pacific3662 (2007-5316)< 0.001Hospital locationRural1 [Reference]Urban nonteaching-2144 (-2767--1521)< 0.001Urban teaching-997 (-1558--435)0.001Type of hospitalizationNon-elective1 [Reference]Elective-749 (-962--536)< 0.001Month of admissionJanuary1 [Reference]February-18 (-160-124)0.804March-68 (-202-65)0.316April-219 (-356--81)0.002May-209 (-347--71)0.003June-117 (-262-27)0.111July-94 (-243-55)0.217August-33 (-187-121)0.675September-11 (-159-138)0.888October229 (82-376)0.002November307 (143-471)< 0.001December115 (-30-260)0.119Admission dayWeekday1 [Reference]Weekend309 (179-440)< 0.001Number of OR procedures4247 (4091-4402)< 0.001Surgical subtypeCardiac15688 (15080-16295)< 0.001Endocrine894 (293-1496)0.004Intraabdominal general3704 (3414-3993)< 0.001Genitourinary2488 (2117-2859)< 0.001Gynecologic-4490 (-4716--4265)< 0.001Heart and lung transplant149958 (133600-166316)< 0.001Neurosurgery6783 (6393-7173)< 0.001Noncardiac transplant95148 (83331-106964)< 0.001Obstetric-3474 (-3787--3160)< 0.001Ophthalmologic2981 (931-5030)0.004Orthopedic5156 (4890-5421)< 0.001Otolaryngology1535 (752-2318)< 0.001Skin and subcutaneous tissue1233 (929-1538)< 0.001Thoracic20546 (19633-21460)< 0.001Vascular11323 (10869-11776)< 0.001ComorbiditiesCongestive heart failure3631 (3293-3968)< 0.001Valvular disease241 (-44-526)0.097Pulmonary circulation disorders14674 (13545-15803)< 0.001Peripheral vascular disease112 (-131-356)0.366Hypertension-1089 (-1258--920)< 0.001Paralysis8140 (7654-8626)< 0.001Other neurological disorders2849 (2605-3092)< 0.001Chronic pulmonary disease-437 (-575--299)< 0.001Diabetes without chronic complications-732 (-858--606)< 0.001Diabetes with chronic complications-1387 (-1633--1140)< 0.001Hypothyroidism129 (6-252)0.04Renal failure911 (645-1176)< 0.001Liver disease-59 (-412-295)0.745Chronic peptic ulcer disease6376 (5490-7262)< 0.001HIV and AIDS2425 (787-4063)0.004Lymphoma3545 (2512-4579)< 0.001Metastatic cancer-2698 (-3437--1959)< 0.001Solid tumor without metastasis-1968 (-2356--1581)< 0.001RA / collagen vascular diseases336 (116-555)0.003Coagulation deficiency10494 (9958-11030)< 0.001Obesity1714 (1569-1859)< 0.001Weight loss13541 (12575-14506)< 0.001Fluid and electrolyte disorders8458 (8069-8847)< 0.001Blood loss anemia1128 (959-1297)< 0.001Deficiency anemias-312 (-528--96)0.005Alcohol abuse987 (620-1355)< 0.001Drug abuse1498 (1154-1842)< 0.001Psychoses889 (557-1222)< 0.001Depression162 (9-314)0.038AIDS = acquired immune deficiency syndrome; HIV = human immunodeficiency virus; K = thousand; M = million; OR = operating room; RA = rheumatoid arthritis.Supplementary Table 8. Baseline Patient and Admission Characteristics Before and After Propensity Score MatchingBefore Propensity Score MatchingAfter Propensity Score MatchingCharacteristicNo IOCANo. (%)(n = 9,239,631)IOCANo. (%)(n = 5,230)SMD, %No IOCANo. (%)(n = 15,155)IOCANo. (%)(n = 5,115)SMD, %Age, years0.6650.04618-392699768 (29.2) 350 (6.7) 865 (5.7) 335 (6.5) 40-592287414 (24.8) 1180 (22.6) 3310 (21.8) 1165 (22.8) 60-793354459 (36.3) 2715 (51.9) 7980 (52.7) 2645 (51.7) 80+897990 (9.7) 985 (18.8) 3000 (19.8) 970 (19.0) Sex0.440.022Male3,525,219 (38.2)3120 (59.7)9170 (60.5)3040 (59.4)Female5714412 (61.8) 2110 (40.3) 5985 (39.5) 2075 (40.6) Race0.1870.046White6152256 (66.6) 3500 (66.9) 10225 (67.5) 3455 (67.5) Black1057475 (11.4) 750 (14.3) 2055 (13.6) 725 (14.2) Hispanic972280 (10.5) 330 (6.3) 880 (5.8) 315 (6.2) Asian or Pacific Islander275035 (3.0) 170 (3.3) 560 (3.7) 160 (3.1) Native American46915 (0.5) 40 (0.8) 115 (0.8) 30 (0.6) Other280895 (3.0) 115 (2.2) 330 (2.2) 115 (2.2) Missing454776 (4.9) 325 (6.2) 990 (6.5) 315 (6.2) Payor status0.4960.021Medicare3575534 (38.7) 3255 (62.2) 9500 (62.7) 3180 (62.2) Medicaid1571744 (17.0) 435 (8.3) 1295 (8.5) 425 (8.3) Private3485384 (37.7) 1310 (25.0) 3735 (24.6) 1285 (25.1) Self-pay275780 (3.0) 105 (2.0) 285 (1.9) 100 (2.0) No charge23895 (0.3) 20 (0.4) 50 (0.3) 20 (0.4) Other307295 (3.3) 105 (2.0) 290 (1.9) 105 (2.1) Hospital ownership0.1460.019Private non-profit 6889046 (74.6) 3950 (75.5) 11435 (75.5) 3900 (76.2) Government, nonfederal1002140 (10.8) 730 (14.0) 2050 (13.5) 675 (13.2) Private invest-own1348444 (14.6) 550 (10.5) 1670 (11.0) 540 (10.6) Patient county size0.0710.036Central metro > 1M2618768 (28.3) 1485 (28.4) 4080 (26.9) 1440 (28.2) Fringe metro > 1M2290429 (24.8) 1195 (22.8) 3575 (23.6) 1170 (22.9) 250K-1M1960109 (21.2) 1060 (20.3) 3140 (20.7) 1040 (20.3) 50-250K865364 (9.4) 540 (10.3) 1500 (9.9) 525 (10.3) Micropolitan857095 (9.3) 530 (10.1) 1550 (10.2) 525 (10.3) Other647865 (7.0) 420 (8.0) 1310 (8.6) 415 (8.1) Median zip code income percentile0.041 0.0230-25th2521503 (27.3) 1505 (28.8) 4265 (28.1) 1460 (28.5) 26th-50th 2349974 (25.4) 1330 (25.4) 3900 (25.7) 1325 (25.9) 51th-75th2321045 (25.1) 1310 (25.0) 3755 (24.8) 1285 (25.1) 76th-100th2047109 (22.2) 1085 (20.7) 3235 (21.3) 1045 (20.4) Census Division0.061 0.041New England418255 (4.5) 240 (4.6) 655 (4.3) 235 (4.6) Mid Atlantic1277935 (13.8) 750 (14.3) 2280 (15.0) 735 (14.4) East North Central1385619 (15.0) 860 (16.4) 2550 (16.8) 845 (16.5) West North Central673005 (7.3) 395 (7.6) 1165 (7.7) 390 (7.6) South Atlantic1896815 (20.5) 1040 (19.9) 2865 (18.9) 1020 (19.9) East South Central641463 (6.9) 370 (7.1) 1150 (7.6) 360 (7.0) West South Central1133191 (12.3) 565 (10.8) 1685 (11.1) 560 (10.9) Mountain620908 (6.7) 340 (6.5) 995 (6.6) 340 (6.6) Pacific1192440 (12.9) 670 (12.8) 1810 (11.9) 630 (12.3) Hospital location0.192 0.032Rural619955 (6.7) 270 (5.2) 840 (5.5) 270 (5.3) Urban nonteaching2244992 (24.3) 910 (17.4) 2865 (18.9) 910 (17.8) Urban teaching6374684 (69.0) 4050 (77.4) 11450 (75.6) 3935 (76.9) Type of hospitalization0.3410.078Non-elective4458922 (48.3)3395 (64.9)10405 (68.7)3325 (65.0)Elective4780709 (51.7) 1835 (35.1) 4750 (31.3) 1790 (35.0) Month of admission0.1020.068January750170 (8.1) 470 (9.0) 1385 (9.1) 460 (9.0) February746645 (8.1) 405 (7.7) 1190 (7.9) 390 (7.6) March786000 (8.5) 505 (9.7) 1340 (8.8) 495 (9.7) April752930 (8.1) 445 (8.5) 1350 (8.9) 430 (8.4) May773325 (8.4) 455 (8.7) 1260 (8.3) 450 (8.8) June783255 (8.5) 390 (7.5) 1140 (7.5) 370 (7.2) July747835 (8.1) 425 (8.1) 1230 (8.1) 425 (8.3) August811980 (8.8) 495 (9.5) 1380 (9.1) 495 (9.7) September762195 (8.2) 360 (6.9) 1140 (7.5) 345 (6.7) October781800 (8.5) 415 (7.9) 1100 (7.3) 415 (8.1) November772310 (8.4) 375 (7.2) 1105 (7.3) 370 (7.2) December771190 (8.3) 490 (9.4) 1535 (10.1) 470 (9.2) Admission day0.0880.005Weekday8,002,337 (86.6)4,365 (83.5)12655 (83.5)4280 (83.7)Weekend1237294 (13.4) 865 (16.5) 2500 (16.5) 835 (16.3) Number of OR procedures*1.76 (1.39)2.85 (2.17)0.5982.59 (1.98)2.77 (2.08)0.085Surgical subtypeCardiac1059449 (11.5) 3205 (61.3) 1.219350 (61.7) 3095 (60.5) 0.024Endocrine47040 (0.5) 35 (0.7) 0.02180 (0.5) 35 (0.7) 0.02Intraabdominal general1799429 (19.5) 1130 (21.6) 0.0533230 (21.3) 1080 (21.1) 0.005Genitourinary492424 (5.3) 235 (4.5) 0.039660 (4.4) 225 (4.4) 0.002Gynecologic836329 (9.1) 95 (1.8) 0.323265 (1.7) 95 (1.9) 0.008Heart and lung transplant4825 (0.1) 40 (0.8) 0.11250 (0.3) 35 (0.7) 0.05Neurosurgery915735 (9.9) 285 (5.4) 0.168735 (4.8) 275 (5.4) 0.024Noncardiac transplant7495 (0.1) 75 (1.4) 0.157155 (1.0) 60 (1.2) 0.014Obstetric1928343 (20.9) 20 (0.4) 0.70530 (0.2) 20 (0.4) 0.036Ophthalmologic13375 (0.1) 5 (0.1) 0.0145 (0.0) 5 (0.1) 0.025Orthopedic3646854 (39.5) 900 (17.2) 0.512130 (14.1) 885 (17.3) 0.089Otolaryngology104090 (1.1) 65 (1.2) 0.011165 (1.1) 65 (1.3) 0.017Skin and subcutaneous tissue681149 (7.4) 400 (7.6) 0.01990 (6.5) 385 (7.5) 0.039Thoracic476619 (5.2) 990 (18.9) 0.4332295 (15.1) 910 (17.8) 0.071Vascular1305799 (14.1) 2690 (51.4) 0.8667525 (49.7) 2575 (50.3) 0.014ComorbiditiesCongestive heart failure436455 (4.7) 795 (15.2) 0.3552200 (14.5) 725 (14.2) 0.01Valvular disease248900 (2.7) 250 (4.8) 0.11735 (4.8) 235 (4.6) 0.012Pulmonary circulation disorders49365 (0.5) 160 (3.1) 0.191375 (2.5) 135 (2.6) 0.01Peripheral vascular disease559190 (6.1) 1070 (20.5) 0.4352885 (19.0) 1045 (20.4) 0.035Hypertension4322444 (46.8) 3335 (63.8) 0.34710070 (66.4) 3280 (64.1) 0.049Paralysis212305 (2.3) 270 (5.2) 0.152705 (4.7) 250 (4.9) 0.011Other neurological disorders489120 (5.3) 410 (7.8) 0.1031255 (8.3) 405 (7.9) 0.013Chronic pulmonary disease1403424 (15.2) 1060 (20.3) 0.1333185 (21.0) 1045 (20.4) 0.014Diabetes without chronic complications1082610 (11.7) 835 (16.0) 0.1232700 (17.8) 815 (15.9) 0.05Diabetes with chronic complications827455 (9.0) 955 (18.3) 0.2742840 (18.7) 940 (18.4) 0.009Hypothyroidism995154 (10.8) 590 (11.3) 0.0161745 (11.5) 585 (11.4) 0.002Renal failure865850 (9.4) 1525 (29.2) 0.5184140 (27.3) 1460 (28.5) 0.027Liver disease251735 (2.7) 280 (5.4) 0.134815 (5.4) 260 (5.1) 0.013Chronic peptic ulcer disease61950 (0.7) 95 (1.8) 0.104275 (1.8) 90 (1.8) 0.004HIV and AIDS10890 (0.1) 5 (0.1) 0.00725 (0.2) 5 (0.1) 0.019Lymphoma36415 (0.4) 30 (0.6) 0.02665 (0.4) 30 (0.6) 0.022Metastatic cancer194039 (2.1) 135 (2.6) 0.032370 (2.4) 135 (2.6) 0.013Solid tumor without metastasis138975 (1.5) 170 (3.3) 0.115440 (2.9) 165 (3.2) 0.019RA / collagen vascular diseases242050 (2.6) 100 (1.9) 0.048275 (1.8) 100 (2.0) 0.01Coagulation deficiency436160 (4.7) 1180 (22.6) 0.5382945 (19.4) 1090 (21.3) 0.047Obesity1532375 (16.6) 1065 (20.4) 0.0973120 (20.6) 1040 (20.3) 0.006Weight loss347810 (3.8) 495 (9.5) 0.2311295 (8.5) 465 (9.1) 0.019Fluid and electrolyte disorders1443159 (15.6) 2480 (47.4) 0.7286915 (45.6) 2385 (46.6) 0.02Blood loss anemia404365 (4.4) 60 (1.1) 0.198110 (0.7) 60.0 (1.2) 0.046Deficiency anemias1236644 (13.4) 1115 (21.3) 0.2113325 (21.9) 1115 (21.8)0.003Alcohol abuse224035 (2.4) 145 (2.8) 0.022480 (3.2) 145 (2.8) 0.019Drug abuse189315 (2.0) 85 (1.6) 0.032215 (1.4) 85 (1.7) 0.02Psychoses187240 (2.0) 65 (1.2) 0.062170 (1.1) 65 (1.3) 0.014Depression908905 (9.8) 460 (8.8) 0.0361380 (9.1) 460 (9.0) 0.004* Displayed as mean (standard deviation).AIDS = acquired immune deficiency syndrome; HIV = human immunodeficiency virus; K = thousand; M = million; OR = operating room; RA = rheumatoid arthritis.Supplementary Table 9. Effect Estimates for Secondary Outcomes from Linear and Logistic Regression Models in the Propensity Score Matched CohortOutcomeEffect EstimateOdds RatioP valueIn-hospital mortality15.1< 0.001 CoefficientP valueLength of stay, days-0.840.053Total cost of hospitalization, dollars8,353< 0.001Supplementary Table 10. Adjusted Odds Ratios for Intraoperative Cardiac Arrest, Full ModelCharacteristicOdds Ratio (95% CI)P valueAge, years18-391 [Reference]40-590.95 (0.7-1.29)0.74360-791.05 (0.77-1.43)0.76680+1.4 (1-1.98)0.052SexMale1 [Reference]Female0.97 (0.85-1.1)0.608RaceWhite1 [Reference]Black1.4 (1.15-1.7)0.001Hispanic0.82 (0.62-1.08)0.165Asian or Pacific Islander1.37 (0.96-1.97)0.083Native American1.69 (0.83-3.47)0.15Other0.81 (0.52-1.24)0.326Missing1.34 (1.01-1.77)0.043Payor statusMedicare1 [Reference]Medicaid0.73 (0.56-0.95)0.019Private0.9 (0.75-1.07)0.23Self-pay0.71 (0.44-1.12)0.14No charge1.35 (0.49-3.71)0.557Other0.65 (0.41-1.04)0.071Hospital ownershipPrivate non-profit 1 [Reference]Government, nonfederal1.5 (1.24-1.82)< 0.001Private invest-own0.88 (0.71-1.1)0.273Patient county sizeCentral metro > 1M1 [Reference]Fringe metro > 1M0.92 (0.76-1.1)0.358250K-1M0.97 (0.81-1.16)0.7450-250K1.09 (0.85-1.39)0.496Micropolitan0.97 (0.76-1.23)0.798Other0.99 (0.75-1.32)0.96Median zip code income percentile0-25th1 [Reference]26th-50th 1 (0.83-1.2)0.99251th-75th1.05 (0.85-1.28)0.66476th-100th1.02 (0.82-1.27)0.851Census DivisionNew England1 [Reference]Mid Atlantic0.92 (0.58-1.45)0.712East North Central0.88 (0.57-1.37)0.575West North Central0.81 (0.5-1.3)0.379South Atlantic0.8 (0.52-1.25)0.329East South Central0.81 (0.49-1.35)0.422West South Central0.82 (0.52-1.31)0.408Mountain0.98 (0.59-1.62)0.934Pacific0.93 (0.59-1.46)0.75Hospital locationRural1 [Reference]Urban nonteaching0.67 (0.48-0.94)0.022Urban teaching0.77 (0.56-1.06)0.105Type of hospitalizationNon-elective1 [Reference]Elective0.91 (0.78-1.06)0.223Month of admissionJanuary1 [Reference]February0.85 (0.63-1.14)0.277March1 (0.75-1.33)0.993April0.92 (0.68-1.25)0.61May0.95 (0.71-1.27)0.746June0.82 (0.61-1.11)0.195July0.93 (0.7-1.24)0.639August1.01 (0.77-1.33)0.95September0.77 (0.57-1.04)0.091October0.84 (0.62-1.13)0.246November0.77 (0.57-1.05)0.095December1.03 (0.77-1.39)0.824Admission dayWeekday1 [Reference]Weekend1.04 (0.87-1.24)0.654Number of OR procedures1.15 (1.11-1.18)< 0.001Surgical subtypeCardiac7.44 (6.11-9.06)< 0.001Endocrine1.76 (0.83-3.75)0.143Intraabdominal general1.17 (0.97-1.42)0.094Genitourinary1.03 (0.75-1.43)0.849Gynecologic0.93 (0.57-1.51)0.765Heart and lung transplant1.15 (0.57-2.34)0.693Neurosurgery1.07 (0.81-1.43)0.624Noncardiac transplant6.19 (3.36-11.4)< 0.001Obstetric0.07 (0.03-0.21)< 0.001Ophthalmologic0.69 (0.09-5.25)0.723Orthopedic0.93 (0.76-1.15)0.529Otolaryngology0.76 (0.44-1.31)0.317Skin and subcutaneous tissue1 (0.78-1.29)0.998Thoracic1.58 (1.32-1.89)< 0.001Vascular1.77 (1.51-2.06)< 0.001ComorbiditiesCongestive heart failure1.97 (1.61-2.41)< 0.001Valvular disease0.93 (0.67-1.28)0.657Pulmonary circulation disorders2.44 (1.67-3.57)< 0.001Peripheral vascular disease1.47 (1.25-1.73)< 0.001Hypertension0.81 (0.7-0.93)0.004Paralysis1.11 (0.83-1.48)0.482Other neurological disorders1.06 (0.84-1.33)0.622Chronic pulmonary disease0.89 (0.76-1.04)0.144Diabetes without chronic complications0.99 (0.83-1.17)0.867Diabetes with chronic complications0.87 (0.72-1.04)0.124Hypothyroidism0.89 (0.73-1.08)0.228Renal failure1.4 (1.2-1.64)< 0.001Liver disease1.19 (0.87-1.62)0.276Chronic peptic ulcer disease1.25 (0.79-2)0.345HIV and AIDS0.56 (0.08-4.09)0.568Lymphoma0.88 (0.39-1.94)0.743Metastatic cancer1.17 (0.79-1.75)0.434Solid tumor without metastasis1.52 (1.06-2.17)0.022RA / collagen vascular diseases0.64 (0.4-1.02)0.059Coagulation deficiency1.54 (1.3-1.81)< 0.001Obesity1.14 (0.97-1.33)0.12Weight loss0.88 (0.7-1.12)0.3Fluid and electrolyte disorders1.81 (1.57-2.09)< 0.001Blood loss anemia0.77 (0.44-1.35)0.359Deficiency anemias0.94 (0.8-1.1)0.446Alcohol abuse0.76 (0.51-1.11)0.154Drug abuse0.78 (0.47-1.28)0.32Psychoses0.66 (0.37-1.19)0.17Depression0.91 (0.73-1.13)0.389AIDS = acquired immune deficiency syndrome; HIV = human immunodeficiency virus; K = thousand; M = million; OR = operating room; RA = rheumatoid arthritis.Supplementary Table 11. Adjusted Odds Ratios for Intraoperative Cardiac Arrest, Subgroup AnalysesObstetric Surgery Admissions ExcludedCardiac Surgery Admissions ExcludedCharacteristicOdds Ratio (95% CI)P valueOdds Ratio (95% CI)P valueAge, years18-391 [Reference]1 [Reference]40-590.91 (0.68-1.22)0.5421.01 (0.64-1.61)0.95460-791.01 (0.75-1.37)0.9241.26 (0.79-1.99)0.33180+1.36 (0.97-1.89)0.0721.31 (0.76-2.25)0.325SexMale1 [Reference]1 [Reference]Female0.97 (0.85-1.1)0.6080.96 (0.78-1.19)0.72RaceWhite1 [Reference]1 [Reference]Black1.4 (1.15-1.71)0.0011.21 (0.91-1.63)0.195Hispanic0.81 (0.62-1.08)0.2350.81 (0.53-1.22)0.308Asian or Pacific Islander1.34 (0.93-1.92)0.1371.07 (0.55-2.11)0.834Native American1.71 (0.83-3.5)0.0731.4 (0.44-4.5)0.569Other0.81 (0.53-1.24)0.2451.05 (0.55-1.98)0.891Missing1.35 (1.02-1.79)0.0061.83 (1.17-2.87)0.008Payor statusMedicare1 [Reference]1 [Reference]Medicaid0.73 (0.56-0.95)0.0110.62 (0.42-0.93)0.02Private0.9 (0.75-1.08)0.2910.99 (0.74-1.33)0.956Self-pay0.71 (0.45-1.13)0.2570.76 (0.36-1.58)0.456No charge1.36 (0.5-3.74)0.4620.96 (0.13-7.08)0.97Other0.66 (0.41-1.04)0.1181.21 (0.69-2.13)0.498Hospital ownershipPrivate non-profit 1 [Reference]1 [Reference]Government, nonfederal1.5 (1.24-1.81)< 0.0011.52 (1.14-2.03)0.004Private invest-own0.89 (0.71-1.11)0.2930.74 (0.52-1.05)0.093Patient county sizeCentral metro > 1M1 [Reference]1 [Reference]Fringe metro > 1M0.91 (0.75-1.09)0.30.84 (0.62-1.14)0.271250K-1M0.96 (0.8-1.16)0.6911.1 (0.84-1.43)0.49350-250K1.08 (0.84-1.38)0.5510.99 (0.67-1.48)0.972Micropolitan0.97 (0.76-1.23)0.780.96 (0.64-1.44)0.838Other0.99 (0.75-1.32)0.9480.79 (0.48-1.27)0.328Median zip code income percentile0-25th1 [Reference]1 [Reference]26th-50th 1 (0.83-1.2)0.9841 (0.76-1.33)0.97951th-75th1.04 (0.85-1.28)0.6770.91 (0.67-1.23)0.53176th-100th1.03 (0.83-1.28)0.8010.73 (0.51-1.05)0.092Census DivisionNew England1 [Reference]1 [Reference]Mid Atlantic0.91 (0.58-1.43)0.6880.97 (0.51-1.87)0.93East North Central0.88 (0.57-1.37)0.5750.95 (0.49-1.83)0.881West North Central0.79 (0.49-1.28)0.3450.77 (0.35-1.69)0.515South Atlantic0.8 (0.51-1.24)0.3170.99 (0.52-1.89)0.967East South Central0.81 (0.49-1.35)0.4170.9 (0.4-1.99)0.786West South Central0.82 (0.52-1.3)0.4050.84 (0.42-1.66)0.606Mountain0.96 (0.58-1.59)0.8780.95 (0.44-2.03)0.888Pacific0.93 (0.59-1.47)0.7630.93 (0.47-1.83)0.833Hospital locationRural1 [Reference]1 [Reference]Urban nonteaching0.67 (0.47-0.94)0.0190.67 (0.41-1.1)0.114Urban teaching0.76 (0.55-1.05)0.0980.66 (0.42-1.05)0.083Type of hospitalizationNon-elective1 [Reference]1 [Reference]Elective0.91 (0.78-1.06)0.2131.06 (0.82-1.37)0.674Month of admissionJanuary1 [Reference]1 [Reference]February0.85 (0.63-1.14)0.2770.82 (0.5-1.35)0.441March1 (0.75-1.33)0.9951.14 (0.71-1.85)0.583April0.92 (0.68-1.25)0.6121.1 (0.69-1.75)0.684May0.94 (0.7-1.26)0.6931.45 (0.94-2.24)0.095June0.82 (0.61-1.11)0.1950.92 (0.55-1.52)0.741July0.92 (0.7-1.23)0.5831.04 (0.63-1.7)0.877August1.01 (0.77-1.33)0.9471.11 (0.69-1.78)0.675September0.77 (0.57-1.04)0.0920.86 (0.5-1.46)0.567October0.84 (0.62-1.13)0.2460.99 (0.6-1.61)0.959November0.76 (0.56-1.03)0.081 (0.62-1.63)0.985December1.02 (0.76-1.37)0.8781.39 (0.88-2.18)0.153Admission dayWeekday1 [Reference]1 [Reference]Weekend1.05 (0.88-1.25)0.6240.92 (0.7-1.23)0.587Number of OR procedures1.15 (1.11-1.18)< 0.0011.1 (1.05-1.16)0Surgical subtypeCardiac7.37 (6.06-8.97)< 0.001ExcludedEndocrine1.76 (0.83-3.75)0.1422.33 (1.02-5.31)0.044Intraabdominal general1.17 (0.97-1.41)0.1111.26 (0.98-1.64)0.076Genitourinary0.99 (0.71-1.37)0.9440.98 (0.67-1.45)0.938Gynecologic0.89 (0.53-1.48)0.6461.42 (0.83-2.43)0.196Heart and lung transplant1.15 (0.57-2.34)0.6916.14 (0.86-43.85)0.07Neurosurgery1.07 (0.81-1.43)0.6321.1 (0.79-1.53)0.565Noncardiac transplant6.22 (3.38-11.45)< 0.0017.28 (3.58-14.79)< 0.001ObstetricExcluded< 0.0010.1 (0.03-0.37)0.001Ophthalmologic0.69 (0.09-5.23)0.724Excluded*Orthopedic0.93 (0.75-1.15)0.4981.02 (0.78-1.31)0.91Otolaryngology0.76 (0.44-1.31)0.3160.69 (0.31-1.54)0.369Skin and subcutaneous tissue1 (0.78-1.29)0.9790.92 (0.66-1.28)0.618Thoracic1.58 (1.32-1.89)< 0.0011.68 (1.26-2.25)< 0.001Vascular1.76 (1.51-2.06)< 0.0013.32 (2.57-4.29)< 0.001ComorbiditiesCongestive heart failure1.98 (1.62-2.42)< 0.0012.02 (1.54-2.65)< 0.001Valvular disease0.91 (0.66-1.26)0.5691.19 (0.77-1.83)0.44Pulmonary circulation disorders2.45 (1.68-3.58)< 0.0012.39 (1.5-3.83)< 0.001Peripheral vascular disease1.47 (1.25-1.73)< 0.0011.95 (1.51-2.52)< 0.001Hypertension0.81 (0.7-0.93)0.0030.92 (0.73-1.16)0.486Paralysis1.11 (0.83-1.48)0.4811.34 (0.91-1.99)0.139Other neurological disorders1.06 (0.84-1.33)0.6171.23 (0.9-1.68)0.202Chronic pulmonary disease0.89 (0.76-1.04)0.1510.85 (0.66-1.1)0.219Diabetes without chronic complications0.99 (0.83-1.18)0.8941.39 (1.06-1.82)0.016Diabetes with chronic complications0.87 (0.72-1.05)0.1390.92 (0.68-1.25)0.597Hypothyroidism0.89 (0.73-1.08)0.2380.99 (0.74-1.34)0.971Renal failure1.4 (1.2-1.64)< 0.0011.7 (1.32-2.19)< 0.001Liver disease1.19 (0.87-1.62)0.2731.07 (0.7-1.63)0.761Chronic peptic ulcer disease1.26 (0.79-2)0.3371.34 (0.73-2.47)0.347HIV and AIDS0.56 (0.08-4.09)0.569Excluded*Lymphoma0.87 (0.39-1.94)0.7390.88 (0.28-2.77)0.832Metastatic cancer1.18 (0.79-1.76)0.4231.25 (0.79-1.98)0.346Solid tumor without metastasis1.52 (1.07-2.17)0.0210.89 (0.49-1.62)0.697RA / collagen vascular diseases0.64 (0.4-1.02)0.0590.43 (0.19-0.96)0.041Coagulation deficiency1.54 (1.31-1.82)< 0.0012.08 (1.59-2.72)< 0.001Obesity1.12 (0.96-1.32)0.1531.04 (0.81-1.34)0.747Weight loss0.89 (0.7-1.12)0.3110.79 (0.56-1.12)0.182Fluid and electrolyte disorders1.81 (1.57-2.09)< 0.0012.29 (1.79-2.92)< 0.001Blood loss anemia0.74 (0.41-1.34)0.3220.66 (0.29-1.5)0.327Deficiency anemias0.93 (0.79-1.1)0.4210.72 (0.55-0.92)0.01Alcohol abuse0.76 (0.52-1.11)0.1560.9 (0.52-1.55)0.695Drug abuse0.73 (0.44-1.21)0.2181.36 (0.76-2.44)0.301Psychoses0.67 (0.37-1.2)0.1730.47 (0.2-1.13)0.092Depression0.91 (0.73-1.13)0.4020.94 (0.69-1.28)0.687* Variable excluded due to perfectly collinearity with outcome within the subgroup.AIDS = acquired immune deficiency syndrome; HIV = human immunodeficiency virus; K = thousand; M = million; OR = operating room; RA = rheumatoid arthritis.Supplementary Table 12. Adjusted Odds Ratios for Intraoperative Cardiac Arrest, Elective Admissions with Procedures on Day 0CharacteristicOdds Ratio (95% CI)P valueAge, years18-391 [Reference]40-590.75 (0.4-1.38)0.35360-790.97 (0.52-1.81)0.92680+1.05 (0.53-2.08)0.898SexMale1 [Reference]Female0.95 (0.73-1.23)0.682RaceWhite1 [Reference]Black1.01 (0.66-1.53)0.975Hispanic0.66 (0.33-1.3)0.231Asian or Pacific Islander1.4 (0.7-2.83)0.341Native American4.92 (1.84-13.13)0.002Other0.91 (0.43-1.9)0.797Missing1.17 (0.62-2.2)0.63Payor statusMedicare1 [Reference]Medicaid0.94 (0.53-1.69)0.842Private1.03 (0.75-1.43)0.846Self-pay0.72 (0.18-2.96)0.654No charge2.84 (0.36-22.31)0.321Other1.1 (0.51-2.4)0.806Hospital ownershipPrivate non-profit 1 [Reference]Government, nonfederal1.55 (1.06-2.26)0.022Private invest-own0.8 (0.51-1.25)0.33Patient county sizeCentral metro > 1M1 [Reference]Fringe metro > 1M0.61 (0.43-0.86)0.006250K-1M0.7 (0.5-0.98)0.03750-250K0.56 (0.34-0.93)0.026Micropolitan0.56 (0.34-0.93)0.026Other0.51 (0.29-0.91)0.021Median zip code income percentile0-25th1 [Reference]26th-50th 0.94 (0.66-1.33)0.71251th-75th0.99 (0.69-1.42)0.96276th-100th0.87 (0.57-1.32)0.503Census DivisionNew England1 [Reference]Mid Atlantic1.58 (0.77-3.24)0.214East North Central1.13 (0.56-2.29)0.735West North Central0.99 (0.43-2.24)0.974South Atlantic1.36 (0.67-2.78)0.394East South Central1.35 (0.6-3.07)0.468West South Central0.91 (0.42-1.98)0.805Mountain1.3 (0.57-2.95)0.53Pacific0.92 (0.43-1.95)0.82Hospital locationRural1 [Reference]Urban nonteaching0.74 (0.36-1.5)0.397Urban teaching0.67 (0.34-1.33)0.253Month of admissionJanuary1 [Reference]February0.56 (0.29-1.08)0.085March1.31 (0.77-2.23)0.323April0.91 (0.49-1.7)0.763May0.98 (0.55-1.74)0.941June0.98 (0.55-1.75)0.958July0.98 (0.55-1.73)0.933August1.03 (0.59-1.81)0.916September0.77 (0.41-1.42)0.398October0.78 (0.42-1.45)0.431November0.99 (0.55-1.77)0.972December1.26 (0.72-2.18)0.415Admission dayWeekday1 [Reference]Weekend1.38 (0.48-3.93)0.551Number of OR procedures1.1 (1.02-1.19)0.013Surgical subtypeCardiac9.77 (5.92-16.12)< 0.001Endocrine1.51 (0.46-4.93)0.494Intraabdominal general1.98 (1.3-3.01)0.002Genitourinary1.44 (0.84-2.44)0.183Gynecologic1 (0.47-2.12)0.997Heart and lung transplantExcludedNeurosurgery1.36 (0.89-2.1)0.157Noncardiac transplant4.17 (0.46-38.02)0.206Obstetric0.06 (0.01-0.54)0.012Ophthalmologic4.1 (0.43-38.78)0.218Orthopedic1.13 (0.69-1.82)0.632Otolaryngology1.27 (0.5-3.24)0.62Skin and subcutaneous tissue0.92 (0.52-1.65)0.784Thoracic1.07 (0.71-1.59)0.752Vascular1.88 (1.33-2.65)< 0.001ComorbiditiesCongestive heart failure2.58 (1.7-3.9)< 0.001Valvular disease1.35 (0.77-2.38)0.292Pulmonary circulation disorders4 (1.63-9.86)0.003Peripheral vascular disease2.1 (1.57-2.8)< 0.001Hypertension0.81 (0.62-1.06)0.123Paralysis1.49 (0.8-2.78)0.207Other neurological disorders1.45 (0.92-2.28)0.113Chronic pulmonary disease1.15 (0.85-1.55)0.37Diabetes without chronic complications1.16 (0.84-1.6)0.383Diabetes with chronic complications0.99 (0.67-1.45)0.943Hypothyroidism0.87 (0.61-1.24)0.438Renal failure1.74 (1.27-2.37)< 0.001Liver disease0.89 (0.44-1.82)0.757Chronic peptic ulcer disease1 (0.3-3.29)0.998HIV and AIDSExcluded*LymphomaExcluded*Metastatic cancer1.98 (1.01-3.89)0.048Solid tumor without metastasis2.37 (1.28-4.41)0.006RA / collagen vascular diseases0.33 (0.11-1.04)0.058Coagulation deficiency1.85 (1.34-2.56)< 0.001Obesity1.23 (0.91-1.66)0.179Weight loss0.94 (0.54-1.63)0.817Fluid and electrolyte disorders2.27 (1.7-3.03)< 0.001Blood loss anemia1.43 (0.56-3.63)0.454Deficiency anemias0.91 (0.65-1.27)0.58Alcohol abuse0.49 (0.16-1.57)0.231Drug abuse0.94 (0.22-3.93)0.93Psychoses0.25 (0.03-1.79)0.167Depression1.07 (0.73-1.59)0.72* Variable excluded due to no elective hospital admissions or perfectly collinearity with outcome within the subgroup.AIDS = acquired immune deficiency syndrome; HIV = human immunodeficiency virus; K = thousand; M = million; OR = operating room; RA = rheumatoid arthritis.Supplementary Table 13. Adjusted Odds Ratios for Intraoperative Cardiac Arrest, Exploratory Analysis, Selected CovarariatesCharacteristicOdds Ratio (95% CI)P valueCoronary artery disease1.25 (1.05-1.50)0.014Prior coronary revascularization0.96 (0.80-1.16)0.696History of stroke0.80 (0.63-1.02)0.071History of thromboembolic disease0.93 (0.70-1.24)0.622Active smoker0.91 (0.75-1.10)0.334Head or neck cancer1.84 (0.94-3.62)0.076Tracheal or laryngeal surgery0.95 (0.68-1.34)0.776Supplementary Table 14. Adjusted Odds Ratios for Mortality During Admissions with Intraoperative Cardiac Arrest, Full ModelCharacteristicOdds Ratio (95% CI)P valueAge, years18-391 [Reference]40-590.63 (0.32-1.25)0.18760-790.68 (0.34-1.35)0.27180+1.45 (0.67-3.13)0.342SexMale1 [Reference]Female1.11 (0.81-1.52)0.535RaceWhite1 [Reference]Black0.85 (0.53-1.37)0.514Hispanic0.87 (0.44-1.7)0.684Asian or Pacific Islander1.26 (0.49-3.29)0.631Native American0.44 (0.05-4.1)0.469Other1.2 (0.49-2.98)0.688Missing1.83 (1.09-3.08)0.022Payor statusMedicare1 [Reference]Medicaid1.11 (0.6-2.04)0.749Private0.57 (0.37-0.87)0.01Self-pay1.65 (0.55-4.96)0.371No charge0.55 (0.05-5.67)0.617Other0.96 (0.4-2.32)0.934Hospital ownershipPrivate non-profit 1 [Reference]Government, nonfederal0.99 (0.64-1.54)0.964Private invest-own0.95 (0.55-1.64)0.859Patient county sizeCentral metro > 1M1 [Reference]Fringe metro > 1M0.84 (0.53-1.35)0.478250K-1M1.26 (0.81-1.97)0.29950-250K1.23 (0.69-2.19)0.481Micropolitan0.9 (0.47-1.72)0.75Other0.75 (0.38-1.45)0.39Median zip code income percentile0-25th1 [Reference]26th-50th 0.84 (0.55-1.29)0.42751th-75th0.84 (0.54-1.31)0.44576th-100th0.96 (0.58-1.6)0.879Census DivisionNew England1 [Reference]Mid Atlantic0.91 (0.46-1.82)0.789East North Central1.03 (0.52-2.05)0.931West North Central0.81 (0.35-1.88)0.629South Atlantic0.67 (0.34-1.34)0.261East South Central0.96 (0.39-2.35)0.932West South Central0.82 (0.4-1.67)0.581Mountain1.17 (0.48-2.82)0.732Pacific1.07 (0.51-2.21)0.861Hospital locationRural1 [Reference]Urban nonteaching0.64 (0.26-1.61)0.346Urban teaching1.02 (0.44-2.38)0.962Type of hospitalizationNon-elective1 [Reference]Elective0.36 (0.25-0.51)< 0.001Month of admissionJanuary1 [Reference]February0.98 (0.49-1.98)0.954March1.58 (0.82-3.05)0.17April0.66 (0.32-1.39)0.277May0.75 (0.37-1.49)0.407June0.52 (0.27-1.02)0.058July0.57 (0.28-1.17)0.125August1.02 (0.52-2)0.944September0.76 (0.34-1.67)0.49October0.75 (0.37-1.53)0.431November0.95 (0.47-1.92)0.893December0.88 (0.46-1.68)0.707Admission dayWeekday1 [Reference]Weekend1.35 (0.9-2.02)0.149Number of OR procedures1.02 (0.95-1.11)0.554Surgical subtypeCardiac0.85 (0.57-1.27)0.43Endocrine0.34 (0.02-5.22)0.442Intraabdominal general1.03 (0.68-1.55)0.893Genitourinary0.8 (0.34-1.86)0.602Gynecologic0.42 (0.11-1.65)0.215Heart and lung transplant0.46 (0.08-2.57)0.374Neurosurgery0.99 (0.48-2.06)0.985Noncardiac transplant0.21 (0.05-0.85)0.028Obstetric15.05 (1.05-216.43)0.046OphthalmologicExcluded*Orthopedic1.05 (0.68-1.63)0.817Otolaryngology0.33 (0.06-1.97)0.224Skin and subcutaneous tissue1.08 (0.6-1.95)0.791Thoracic1.31 (0.85-2.02)0.223Vascular1.51 (1.07-2.14)0.019ComorbiditiesCongestive heart failure0.9 (0.58-1.4)0.633Valvular disease1.77 (0.84-3.75)0.134Pulmonary circulation disorders2.84 (1.23-6.58)0.015Peripheral vascular disease1.76 (1.16-2.65)0.008Hypertension0.83 (0.6-1.15)0.273Paralysis0.66 (0.32-1.36)0.263Other neurological disorders1.33 (0.79-2.24)0.291Chronic pulmonary disease1.14 (0.77-1.68)0.522Diabetes without chronic complications0.89 (0.58-1.36)0.593Diabetes with chronic complications0.89 (0.56-1.41)0.618Hypothyroidism1.34 (0.85-2.11)0.212Renal failure1.05 (0.73-1.53)0.778Liver disease3.34 (1.61-6.92)0.001Chronic peptic ulcer disease0.77 (0.27-2.21)0.628HIV and AIDSExcluded*Lymphoma1.98 (0.4-9.7)0.401Metastatic cancer1.4 (0.56-3.52)0.468Solid tumor without metastasis0.71 (0.26-1.94)0.502RA / collagen vascular diseases1.25 (0.49-3.23)0.638Coagulation deficiency1.02 (0.69-1.52)0.903Obesity0.96 (0.65-1.42)0.83Weight loss0.69 (0.4-1.21)0.196Fluid and electrolyte disorders1.22 (0.89-1.66)0.216Blood loss anemia0.08 (0.01-0.46)0.005Deficiency anemias1.03 (0.7-1.5)0.892Alcohol abuse0.74 (0.32-1.68)0.466Drug abuse0.2 (0.04-1.05)0.057Psychoses1.99 (0.63-6.35)0.242Depression0.47 (0.27-0.84)0.01* Variable excluded due to no elective hospital admissions or perfectly collinearity with outcome within the subgroup.AIDS = acquired immune deficiency syndrome; HIV = human immunodeficiency virus; K = thousand; M = million; OR = operating room; RA = rheumatoid arthritis.References ADDIN EN.REFLIST 1.Beta Clinical Classifications Software (CCS) for ICD-10-CM/PCS. Healthcare Cost and Utilization Project (HCUP). October 2018. Agency for Healthcare Research and Quality, Rockville, MD.. Accessed November 5, 2018. ................
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