Characterizing center-level variation in outcomes after the development of pulmonary complications in elective cardiac operations.
- 1Department of Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Calif.
- 2Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
Abstract
Objective
Postoperative 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
Adults (≥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
Among 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
PCs 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.
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BibTeX
@article{ali2026characterizing,
title = {{Characterizing center-level variation in outcomes after the development of pulmonary complications in elective cardiac operations.}},
author = {Konmal Ali and Syed Shaheer Ali and Troy Coaston and Sidney Hinks and Owen Lai and Deep Mehta and Melissa Justo and Yas Sanaiha and Peyman Benharash},
journal = {JTCVS open},
year = {2026},
month = jul,
doi = {10.1016/j.xjon.2026.101973},
url = {https://europepmc.org/article/MED/42948108},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Characterizing center-level variation in outcomes after the development of pulmonary complications in elective cardiac operations.
AU - Konmal Ali
AU - Syed Shaheer Ali
AU - Troy Coaston
AU - Sidney Hinks
AU - Owen Lai
AU - Deep Mehta
AU - Melissa Justo
AU - Yas Sanaiha
AU - Peyman Benharash
PY - 2026
DA - 2026/07/24
JO - JTCVS open
DO - 10.1016/j.xjon.2026.101973
UR - https://europepmc.org/article/MED/42948108
AB - Objective Postoperative 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 Adults (≥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 Among 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 PCs 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.
SN - 2666-2736
ER -