{
  "abstract": "Objective\n\nPostoperative pulmonary complications (PCs) affect 5% to 25% of patients who undergo cardiac surgery. Variation in hospital-management strategies and resource availability may contribute to the incidence of PCs. We assessed the association of PCs with clinical outcomes after elective cardiac surgery and hospital-level variation across the United States.Methods\n\nAdults (≥18 years) undergoing elective coronary, valvular, or proximal aortic operations were identified from the 2016-2022 Nationwide Readmissions Database. PC was defined as a composite of postoperative pneumonia, prolonged mechanical ventilation (>24 hours), reintubation, or tracheostomy. Primary outcome was in-hospital mortality; secondary outcomes included length of stay, hospitalization costs, nonhome discharge, and 30-day nonelective readmission. Multivariable logistic and linear regression models were used for risk adjustment. Mixed-effects modeling quantified hospital-level variation, with center-level effects assessed using the intraclass correlation coefficient.Results\n\nAmong 862,984 patients, 38,596 (4.47%) experienced a PC, most commonly pneumonia (11.5%). Patients with PC were older and had greater comorbidity burden (P < .001). After adjustment, PCs were associated with increased odds of in-hospital mortality (adjusted odds ratio, 1.24; 95% CI, 1.08-1.43), prolonged length of stay (β +0.76 days), greater hospitalization costs (β +$3871), and greater likelihood of nonhome discharge (all P < .001). PC was also associated with decreased freedom from 30-day readmission. Hospital-level factors accounted for 15.3% of the observed variation in PC incidence, with greater institutional PC rates correlated with increased hospitalization expenditures.Conclusions\n\nPCs remain a persistent challenge, driving an increase in mortality and an estimated incremental increase in expenditures of $3800. Significant center-level variation suggests opportunities for quality improvement through targeted interventions addressing modifiable risk factors.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Calif.",
    "Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Konmal Ali"
    },
    {
      "affs": [
        0
      ],
      "name": "Syed Shaheer Ali"
    },
    {
      "affs": [
        0
      ],
      "name": "Troy Coaston"
    },
    {
      "affs": [
        0
      ],
      "name": "Sidney Hinks"
    },
    {
      "affs": [
        0
      ],
      "name": "Owen Lai"
    },
    {
      "affs": [
        0
      ],
      "name": "Deep Mehta"
    },
    {
      "affs": [
        0
      ],
      "name": "Melissa Justo"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Yas Sanaiha"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Peyman Benharash"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/06fw0pjz8qjnq.bib",
  "cited_by": 0,
  "doi": "10.1016/j.xjon.2026.101973",
  "fulltext_url": "https://europepmc.org/articles/PMC13711196",
  "id": "06fw0pjz8qjnq",
  "issns": [
    "2666-2736"
  ],
  "landing_url": "https://europepmc.org/article/MED/42948108",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Adult: Perioperative Management"
    ],
    [
      "openalex",
      "2705|Cardiac, Anesthesia and Surgical Outcomes"
    ]
  ],
  "openalex": "W7170680969",
  "pdf_url": "https://europepmc.org/articles/PMC13711196?pdf=render",
  "pmcid": "PMC13711196",
  "pmid": "42948108",
  "published": "2026-07-24",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/06fw0pjz8qjnq.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T00:20:36Z",
      "native_id": "MED:42948108",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42948108"
    },
    {
      "first_seen": "2026-10-31T12:22:01Z",
      "native_id": "PMC13711196",
      "source": "pmc",
      "url": "https://doi.org/10.1016/j.xjon.2026.101973"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Cardiac, Anesthesia and Surgical Outcomes",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Characterizing center-level variation in outcomes after the development of pulmonary complications in elective cardiac operations.",
  "title_text": "Characterizing center-level variation in outcomes after the development of pulmonary complications in elective cardiac operations.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T12:22:01Z",
  "url": "https://research.draconitic.com/paper/06fw0pjz8qjnq",
  "venue": "JTCVS open",
  "versions": []
}