Age ≥ 56 years, male, active congestive heart failure, ascites, hypertension, preoperative creatinine > 106 mol/L, diabetes mellitus (controlled by either oral medication or insulin injections), ventilator dependence, chronic obstructive pulmonary disease, smoking, coagulation disorders, cancer, obesity, and long-term steroid use. Here, INS is linked to chronic obstructive pulmonary disease.