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The final hierarchical regression model had an area under the

Interactions among the variables were investigated by using interaction terms in the logistic regression analysis and the margins and marginsplot commands in Stata, and significant interactions were retained.Finally, the logistic regression model thus created was further refined by adjustment for random effects within hospitals with Stata’s meqrlogit command, which uses the QR decomposition of the variance components matrix to improve convergence. As the hierarchical component changed the odds ratios for the primary predictor by >10%, it was retained. The final hierarchical regression model had an area under the ROC curve of 0.833 and no evidence of collinearity with a maximum variance inflation factor of 1.37.Subgroup analysesThe hierarchical model was also used to investigate the association between transfusion and stroke/myocardial infarction in surgical subgroups total or partial colectomy, small bowel resection, hip or knee replacement or revision, laminectomy and/or fusion of the spine, and hysterectomy on the basis of ICD 9 codes.We used the same model in a subgroup restricted to patients who received no more than one unit of blood and in a subgroup in which we additionally excluded any patient who received transfusion on the day after surgery (that is, we included only patients who received transfusions on the day of surgery and those who had never received transfusion; the primary analysis already excluded patients who received transfusion on days two to seven after surgery).

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