title: Complications After Cardiac Operations: All Are Not Created Equal.
abstract: BACKGROUND
  Postoperative complications are associated with increased morbidity and mortality after cardiac operations. We sought to quantify the effect of multiple complications on noninstitutionalized recovery after cardiac operations.
  
  
  METHODS
  We identified 2,477 adult patients from our institutional cardiac surgery database who underwent one of seven index cardiac surgical operations from 2011 to 2014. We calculated failure-to-rescue rates for all individual complications and combinations of complications. We used multivariable logistic regression to determine the effect of the interaction of postoperative complications on our primary outcome of operative death and secondary outcomes of prolonged hospital length of stay and discharge to a location other than home.
  
  
  RESULTS
  From 2011 to 2014, at least one complication occurred in 366 patients (14.8%), and multiple complications occurred in 102 (4.1%), including three complications in 20 (0.8%). Operative mortality occurred in 41% of patients with multiple complications vs in 4.9% of those with an isolated complication and in 0.7% of those without complications. Significant interactions that negatively affected survival were noted between nearly every combination of complications. The occurrence of renal failure and unplanned reoperation together were associated with increased deaths (odds ratio, 108.4; 95% confidence interval, 13.5 to 869.9; p < 0.001). Median hospital length of stay and discharge rates to a location other than home correlated positively with the number of postoperative complications.
  
  
  CONCLUSIONS
  Major complications after cardiac operations are associated with an increased risk for operative death, longer hospital length of stay, and higher rates of discharge to a location other than home. These adverse outcomes are magnified when multiple complications are encountered.
authors.affiliation: Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Todd C
authors.initials: TC
authors.lastname: Crawford
authors.affiliation: Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: J Trent
authors.initials: JT
authors.lastname: Magruder
authors.affiliation: Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Grimm
authors.affiliation: Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Suarez-Pierre
authors.affiliation: Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Sciortino
authors.affiliation: Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Kaushik
authors.initials: K
authors.lastname: Mandal
authors.affiliation: Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Kenton J
authors.initials: KJ
authors.lastname: Zehr
authors.affiliation: Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: John V
authors.initials: JV
authors.lastname: Conte
authors.affiliation: Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Higgins
authors.affiliation: Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Duke E
authors.initials: DE
authors.lastname: Cameron
authors.affiliation: Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: gwhitman@jhmi.edu.
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Whitman
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology