Intraoperative Surgical Apgar (Gawande 2007 Table 1) from estimated blood loss, lowest mean arterial pressure, and lowest heart rate, summed to a 0–10 total. Returns score_le_4 because scores ≤4 were associated with 58.6% 30-day death or major complication in the validation cohort (9–10 associated with 3.6%). Deterministic published arithmetic with citation; not Virginia Apgar; not operative clearance.

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