Associations between preoperative risks of postoperative complications: Results of an analysis of 4.8 Million ACS-NSQIP patients

Surgical Risk Preoperative Assessment System (SURPAS) estimates patient's preoperative risk of 12 postoperative complications, yet little is known about associations between these probabilities- We sought to examine relationships between predicted probabilities. Risk of 12 postoperative complications was calculated using SURPAS and the 2012–2018 ACS-NSQIP database. Pearson correlation coefficients (r) were computed to examine relationships between predicted outcomes. “High-risk” was predicted risk in the 10th decile. 4,777,267 patients were included. 71.1% were not high risk, 10.7% were high risk for 1, and 18.2% were high risk for ≥2 complications. High mortality risk was associated with high risk for pulmonary (r = 0.94), cardiac (r = 0.98), renal (r = 0.93), and stroke (0.96) complications. Patients high-risk for ≥2 complications had the most comorbidities and actual adverse outcomes. High preoperative risk for certain postoperative complications had strong correlations. 18.2% of patients were high-risk for ≥2 complications and could be targeted for risk reduction interventions. [Display omitted] •Preoperative assessment of predicted surgical risk identifies vulnerable patients.•Our surgical risk calculator predicts high-risk for postoperative complications.•Preoperatively predicted surgical risks are associated with each other.•Patients at preoperatively predicted risk of ≥2 adverse outcomes are vulnerable.•Patients predicted as high-risk of ≥2 adverse outcomes have most adverse outcomes.