title: Seminal Postoperative Complications and Mode of Death After Pediatric Cardiac Surgical Procedures.
abstract: BACKGROUND
  Understanding the seminal complications leading to death after pediatric cardiac surgical procedures may provide opportunities to reduce mortality. This study analyzed all deaths at two pediatric cardiac surgical programs and developed a method to identify the seminal complications and modes of death.
  
  
  METHODS
  Trained nurses abstracted all cases of in-hospital mortality meeting inclusion criteria from each site over 5 years (2008 to 2012). Complication definitions were consistent with those of a multicenter clinical registry. An adjudication committee assigned a seminal complication in each case (the complication initiating the cascade of events leading to death). Seminal complications were grouped into categories to designate "mode of death." The epidemiology of seminal complications and of mode of death was described.
  
  
  RESULTS
  In 191 subjects, low cardiac output syndrome (71% of all subjects), cardiac arrest (52%), and arrhythmia (48%) were the most common complications. The committee assigned low cardiac output syndrome (30%), failure to separate from bypass (16%), and cardiac arrest (12%) most frequently as seminal complications. Seminal complications occurred a median 2 hours (interquartile range [IQR], 0 to 35 hours) postoperatively. Patients experienced a median of seven (IQR, 3 to 12) additional complications before death at a median of 15 days (IQR, 4 to 46). Systemic circulatory failure was the most common mode of death (51%), followed by inadequate pulmonary blood flow (13%) and cardiac arrest (12%).
  
  
  CONCLUSIONS
  Seminal complications occurred early postoperatively, and systemic circulatory failure was the most common mode of death. Our classification system is likely scalable for subsequent multicenter analysis to understand cause-specific mortality variation across hospitals and to drive quality improvement.
authors.affiliation: Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan. Electronic address: mgaies@med.umich.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Gaies
authors.affiliation: Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Sara K
authors.initials: SK
authors.lastname: Pasquali
authors.affiliation: Michigan Congenital Heart Outcomes Research and Discovery Unit, Ann Arbor, Michigan.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Donohue
authors.affiliation: Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Dimick
authors.affiliation: Division of Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Sarah
authors.initials: S
authors.lastname: Limbach
authors.affiliation: Division of Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Nancy
authors.initials: N
authors.lastname: Burnham
authors.affiliation: Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Chitra
authors.initials: C
authors.lastname: Ravishankar
authors.affiliation: Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Ohye
authors.affiliation: Division of Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.affiliation: Division of Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Mascio
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002423:Cause of Death / Q000639:trends; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012042:Registries; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology