Work

Characterizing center-level variation in outcomes after the development of pulmonary complications in elective cardiac operations

Year: 2026

Type: article

Abstract: Objective Postoperative pulmonary complications (PC) affect 5-25% of cardiac surgery patients. Variation in hospital management strategies and resource availability may contribute to PC incidence. We assessed the association of PC with clinical outcomes following elective cardiac surgery and hospital-level variation across the US. 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, non-home 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 PC, most commonly pneumonia (11.5%). Patients with PC were older and had greater comorbidity burden (p<0.001). After adjustment, PC was associated with increased odds of in-hospital mortality (AOR 1.24, 95% CI 1.08-1.43), prolonged LOS (β +0.76 days), higher hospitalization costs (β +$3,871), and greater likelihood of non-home discharge (all p<0.001). 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 higher institutional PC rates correlated with increased hospitalization expenditures. Conclusion PC remains a persistent challenge, driving an increase in mortality and an estimated incremental increase in expenditures of $3,800. Significant center-level variation suggests opportunities for quality improvement through targeted interventions addressing modifiable risk factors.

Source: JTCVS Open

DOI: 10.1016/j.xjon.2026.101973