| Any patient undergoing non-cardiothoracic surgery and |
| 1. is ≥45 years old; |
| 2. has an expected length of stay ≥48 h; |
| 3. is undergoing a procedure amenable to postoperative epidural analgesia; AND |
| 4. fulfills any of the following SIX criteria |
| i. history of coronary artery disease; |
| ii. history of peripheral vascular disease; |
| iii. history of atherothrombotic stroke; |
| iv. hospitalization for congestive heart failure within three years of randomization; |
| v. undergoing major vascular surgery; OR |
| vi. has at least THREE of the following factors |
| a. any history of congestive heart failure, |
| b. diabetes currently requiring oral hypoglycemic or insulin therapy, |
| c. history of transient ischemic attack, |
| d. history of chronic obstructive pulmonary disease, |
| e. preoperative serum creatinine >175 µmol/L, |
| f. age >70 years, |
| g. anticipated duration of anesthesia ≥3 h, |
| h. intraperitoneal or intrathoracic surgery, |
| i. surgery that must be undertaken within 24 h of acute presentation to hospital |
