Failure to rescue as a quality metric in congenital heart surgeries in a high- complexity service provider institution located in a middle-income country

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Vélez, Jessica Largo, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2908809/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Jan, 2024 Read the published version in Congenital Heart Disease → Version 1 posted You are reading this latest preprint version Abstract Background Failure to rescue has been an effective quality metric in congenital heart surgery. Conversely, morbidity and mortality depend greatly on non-modifiable individual factors and have a weak correlation with better-quality performance. We aim to measure the complications, mortality, and risk factors in pediatric patients undergoing congenital heart surgery in a high-complexity institution located in a low-income country and compare it with other institutions that have conducted a similar study. Methods A retrospective observational study was conducted in a high-complexity service provider institution, in Cali, Colombia. All pediatric patients undergoing any congenital heart surgery between 2019 and 2022 were included. The main outcomes evaluated in the study were complication, mortality, and failure to rescue rate. Univariate and multivariate logistic regression analysis was performed with mortality as the outcome variable. Results We evaluated 308 congenital heart surgeries. Regarding the outcomes, 201 (65%) complications occurred, 23 (7.5%) patients died, and the FTR of the entire cohort was 11.4%. The presence of a postoperative complication (OR 14.88, CI 3.06-268.37, p = 0.009), age (OR 0.79, CI 0.57–0.96, p = 0.068), and urgent/emergent surgery (OR 8.14, CI 2.97–28.66, p < 0.001) were the most significant variables in predicting mortality. Conclusions Failure to rescue is an effective and comparable quality measure in healthcare institutions and is the major contributor to postoperative mortality in congenital heart surgeries. Despite our higher mortality and complication rate, we obtained a comparable failure to rescue rate to high-income countries' health institutions. Congenital heart surgery complication mortality failure to rescue quality metric Figures Figure 1 Introduction The high complexity of congenital heart surgeries (CHS) is related to a higher rate of complications and mortality compared to other types of surgeries [ 1 ]. In addition, congenital heart disease is the leading contributor to infant mortality resulting from birth defects and at least a third of pediatric patients with CHS have reported postoperative complications [ 2 ]. A complication within the in-hospital context refers to an adverse event associated with an acquired disease or a health center intervention, different from the expected natural course of evolution [ 3 ]. These events negatively affect outcomes, increasing the length of stay, hospital costs and mortality [ 4 ]. Throughout the years, the rate of postoperative complications and mortality in CHS have been used to determine the quality of service of health institutions [ 5 ]. However, morbidity and mortality depend greatly on non-modifiable individual factors, independent of the quality of health service and the institution [ 6 , 7 ]. This can cause significant differences in complication and mortality rates between health institutions that do not necessarily mean better or worse service quality. In an analysis of the largest database of CHS in North America, the CHS database of the society of thoracic surgeons (STS-CHSDB), postoperative outcomes and associated variables were evaluated. One of the most relevant findings was that morbidity and mortality largely depend on patient preoperative factors, their health status, and the complexity level of the surgery, variables unrelated to the institutions' quality of service [ 6 ]. Failure to rescue (FTR), defined as the mortality of patients who experienced complications, has been an effective quality measure used in different pediatric surgical procedures [ 6 , 8 – 10 ]. Similarly, FTR studies have been conducted in CHS including institutions of different incomes, resources, and levels [ 4 – 6 , 9 , 11 ]. Our study aims to present the complications, mortality, and risk factors in pediatric patients undergoing CHS in a high-complexity University institution located in a middle-income country and compare it with other institutions that have conducted a similar study. Most of the literature regarding postoperative complications and mortality in CHS is focused on high-income countries, while there is limited knowledge about this topic in low and middle-income countries [ 11 ]. Methods Study Design A retrospective observational study was conducted in a high-complexity University hospital, La Fundación Valle Del Lili in Cali, Colombia. All pediatric patients (under 18 years old) undergoing any CHS between November 2019 and May 2022 were included. Patients with any oncoproliferative disease were excluded. We only analyzed the patient´s first cardiovascular procedure. There was no change in personnel during the study period. Variables Patient demographics, preoperative clinical status, surgery conditions, and outcomes were searched in the patient´s medical records. Each patient was assigned a study ID to ensure anonymity. The variables were annotated in the institution's clinical database management system by the researchers, a platform for protected data collection. For demographic variables, we identified the patients' age, sex, weight, and height. Preoperative clinical variables included risk factors and established pathologies including low weight for age, low weight for height, prematurity, history of cardiac surgeries, number of cardiac surgeries in the actual hospitalization, and history of pulmonary, hepatic, neurologic, or endocrine disease. For the surgery condition variables, we established the diagnosis, the type of surgery performed, the RACHS-1, and the level of urgency (elective or urgent/emergency) for each procedure. The main outcomes evaluated in the study were complication, mortality, and FTR rates. The definition of each complication was based on the classification established in the STS-CHS database (version 2.50) [ 6 ]. We included cardiovascular (cardiac dysfunction, cardiac failure, cardiac arrest, arrhythmias, pericardial effusion, systemic vein obstruction, pulmonary vein obstruction), respiratory (respiratory insufficiency, pneumonia, pneumothorax, pleural effusion, pulmonary hypertension, chylothorax), renal (renal failure), infectious (sepsis, endocarditis), reintervention (secondary to bleeding, cardiac or non-cardiac causes, and unplanned catheterization), neurological (deficits, seizures, stroke, subdural hematoma, intraventricular hemorrhage), wound-related (dehiscence and surgical site infection), anesthetic-related, rehospitalization within 30 days, multiorgan failure and other postoperative complications. Delayed sternal closure was not included as a complication because the sternum was often left open due to institutional protocol and the patient's hemodynamic status. Statistical method All statistical analyses were performed using R statistical software version 4.2.1 (R Foundation for Statistical Computing) through RStudio 2022.12.0. For descriptive analysis, the normality of continuous variables was evaluated using the Shapiro-Wilk test. If the assumption of normality was rejected, these variables were presented as a median and interquartile range, and if not rejected, they were presented as a mean and a standard deviation. Qualitative variables were described using absolute frequencies and percentages. Operative mortality, rate of at least one complication, and FTR rate were calculated and presented with 95% confidence intervals. Univariate and multivariate logistic regression analysis was performed with mortality as the outcome variable. For the multivariate model, variables that were statistically significant based on their p-value and confidence intervals were selected. A statistical significance level of 5% was used in all tests. Ethical considerations This study was approved by the Institutional Ethics Committee (approval number 628–2022 Act No. I22-112 of November 02, 2022) following national and international recommendations for human research. In accordance with resolution 8430 of 1993, this study was considered risk-free, and the waiver of informed consent was requested and obtained. Results A total of 308 pediatric patients undergoing CHS were included. The socio-demographic information and clinical characteristics of the patients are presented in Table 1 . The median age of the participants was 0.6 years (Confidence Interval (CI) 0.2-3.0). The most common age group was infants (39.3%), followed by newborns (24.4%), toddlers (20.8%), kids (13.6%), and adolescents (1.9%). Regarding the outcomes, 201 (65%) complications occurred, 23 (7.5%) patients died, and the FTR of the entire cohort was 11.4% (Table 1 ). Mortality and FTR varied depending on the age group and the RACH-1 classification. Younger patients and higher RACH-1 surgeries had a strong association with mortality and FTR (Table 2 ). Table 1 Sociodemographic information and clinical characteristics of the participants. Variable N N = 308 Demographic variables 308 Age Age in years 0.6 (0.2, 3.0) 1 Newborns (< 1 month) 75 (24.4%) Infants (1–12 months) 121 (39.3%) Toddler (1–5 years) 64 (20.8%) Kids (6–13 years) 42 (13.6%) Adolescent (13–18 years) 6 (1.9%) Sex Female 144 (46.8%) Male 164 (53.2%) Weight (kg) 6.0 (3.6, 12.2) 1 Height (cm) 64.5 (51.0, 96.0) 1 Preoperative clinical status 308 Medical history Pulmonary disease 58 (18.9%) Neurologic disease 74 (24.1%) Hepatic disease 15 (4.9%) Endocrine disease 36 (11.7%) Previous cardiac surgeries 75 (24.5%) Surgeries during hospitalization 1 201 (65.3%) 2 49 (15.9%) 3 23 (7.5%) ≥ 4 35 (11.4%) Low weight-for-age 305 133 (43.6%) Low weight-for-height 303 96 (31.7%) Premature 304 49 (16.1%) Surgery conditions RACHS-1 308 Not classifiable 17 (5.5%) 1 94 (30.5%) 2 104 (33.8%) 3 54 (17.5%) 4 23 (7.46%) 5 10 (3.2%) 6 6 (1.9%) Elective 184 (59.7%) Urgent/Emergency 124 (40.3%) Outcomes 308 Deaths and mortality 23 (7.5%) Complications* 201 (65.2%) Failure to rescue 11.44% 1 Median (IQR); * Patients with at least one complication. Table 2 Mortality, complication, and FTR rate in different age groups and RACHS-1. Age group RACHS TS PC (%) MO (%) FTR (%) < 1 month NC 2 50,00 0,00 0,00 1 9 66,67 0,00 0,00 2 23 78,26 8,70 11,11 3 28 92,86 10,71 11,54 4 11 100,00 18,18 18,18 5 5 80,00 40,00 50,00 6 2 100,00 100,00 100,00 Total 80 78,75 13,75 16,18 1–12 months NC 11 27,27 0,00 0,00 1 43 55,81 0,00 0,00 2 44 72,73 2,27 3,13 3 9 100,00 22,22 22,22 4 7 71,43 14,29 20,00 5 5 80,00 60,00 75,00 6 3 100,00 66,67 66,67 Total 122 64,75 7,38 11,25 1–5 years NC 3 0,00 0,00 0,00 1 24 25,00 4,17 16,67 2 22 68,18 4,55 6,67 3 9 55,56 0,00 0,00 4 5 60,00 0,00 0,00 5 0 0,00 0,00 0,00 6 0 0,00 0,00 0,00 Total 63 41,27 3,17 6,90 6–13 years NC 1 100,00 0,00 0,00 1 15 40,00 0,00 0,00 2 14 71,43 0,00 0,00 3 7 85,71 14,29 16,67 4 0 0,00 0,00 0,00 5 0 0,00 0,00 0,00 6 1 0,00 0,00 0,00 Total 38 60,53 2,63 4,35 13–18 years NC 0 0,00 0,00 0,00 1 3 0,00 0,00 0,00 2 1 100,00 0,00 0,00 3 1 0,00 0,00 0,00 4 0 0,00 0,00 0,00 5 0 0,00 0,00 0,00 6 0 0,00 0,00 0,00 Total 5 20,00 0,00 0,00 RACHS-1 : risk adjustment for congenital cardiovascular surgeries, TS : total surgeries, PC : postoperative complications, MO : mortality, FTR : failure to rescue, NC : not classifiable. In our cohort, most of the patients who presented a postoperative complication had more than 4 complications (30%) (Table 3 ). The most common complications were cardiac dysfunction (33%), respiratory insufficiency (30%), pleural effusion (24%), and multiorgan failure (22%) (Table 3 ). Table 3 Spectrum of postoperative complications Complications N = 308 Number of complications per patient 0 109 (35.4%) 1 21 (6.8%) 2 33 (10.7%) 3 29 (9.4%) 4 23 (7.5%) > 4 93 (30.2%) Cardiovascular Cardiac disfunction 100 (32.5%) Cardiac failure 41 (13.3%) Arrhythmias 45 (14.6%) Cardiac arrest 36 (11.7%) Pulmonary vein obstruction 9 (2.9%) Pericardial effusion 9 (2.9%) Systemic vein obstruction 8 (2.6%) Pulmonary Respiratory insufficiency 91 (29.5%) Pleural effusion 75 (24.1%) Pulmonary hypertension 56 (18.2%) Pneumonia 47 (12.01%) Pneumothorax 28 (9.1%) Chylothorax 13 (4.22%) Infectious Sepsis 36 (11.7%) Endocarditis 6 (1.9%) Reintervention Cardiac 63 (20.5%) Non-cardiac causes 40 (12.9%) Secondary to bleeding 21 (6.8%) Unplanned catheterization 21 (6.8%) Neurological Subdural bleed 19 (6.1%) Deficit of neurologic function 29 (9.4%) Seizures 19 (6.1%) Hematoma 8 (2.6%) Stroke 7 (2.3%) Intraventricular hemorrhage 5 (1.6%) Wound-related Surgical site infection 15 (4.9%) Dehiscence 11 (3.6%) Other Multiorgan failure 67 13 Renal failure 52 (16.9%) Other 27 (8.8%) Anesthetic-related 23 (7.5%) Rehospitalization within 30 days 20 (6.5%) 1 Median (IQR); n (%) Within the univariate analysis, the variables of a postoperative complication (OR 14.88, CI 3.06-268.37, p = 0.009), age (OR 0.79, CI 0.57–0.96, p = 0.068), and urgent/emergent surgery (OR 8.14, CI 2.97–28.66, p < 0.001) were the most significant in predicting mortality (Table 4 ). Therefore, these three variables were included in the multivariate analysis, finding that both the presence of a complication and urgent/emergent surgery were independent risk factors for death. Age was a protective factor, given that the OR was less than 1, though a higher age was associated with a lower risk of mortality (Table 4 ). This age-mortality association was also evidenced in Table 2 . Table 4 Univariate and multivariate analysis for prediction of postoperative mortality Variable OR, CI, p value (univariate) OR, CI, p value (multivariate) PO complication 14.88, 3.06-268.37, p = 0.009) 8.92 (1.76-162.87, p = 0.036) Age (years) 0.79, 0.57–0.96, p = 0.068 0.90 (0.69–1.06, p = 0.316) Urgent/emergent surgery 8.14, 2.97–28.66, p < 0.001 5.01 (1.75–18.11, p = 0.006) Low weight-for-age 0.99, 0.41–2.34, p = 0.990 Low weight-for-height 1.25, 0.49–3.04, p = 0.625 Premature 1.25, 0.49–3.04, p = 0.625 Previous cardiac surgeries 0.63, 0.18–1.74, p = 0.413 OR : odds ratio, CI : confidence interval, PO : postoperative We compared our results with 2 similar studies: the STS-CHSDB (study 1)[ 6 ] and the Pediatric cardiac surgery program with limited systemic resources (study 2) [ 11 ]. In general, our patients were younger, and smaller, presented a significantly higher complication rate, and more urgent/emergent surgeries were performed. The mortality rate resulted in 3.7% in study 1 and 23.4% in study 2. On the other hand, FTR resulted in 9.1%, and 23.3% respectively (Table 5 ). Table 5 Patient characteristics, Mortality, and FTR in studies 1, 2, and 3. COP Studies 1* n = 40,930 2* n = 296 3* = 308 Weight 6.7 (3.9–14.7) 1 8.0 (3.9–14.5) 1 6.0 (3.6, 12.2) 1 Age 0.58 (0.15–3.6) 1 0.76 (0.13–2.9) 1 0.6 (0.2, 3.0) 1 < 1 month 21% 22.8% 24.4% 1–12 months 37% 34.7% 39.3% E/U NA 29.4% 40.3% NC/GA 30% 25% 35% PCS 31% 13.2% 24.5% ST 1,2/ RA 1–2 58% 80.8% 64.3% 1 ≥ complication 39.3% 24.7% 65.2% Mortality 3.7% 5.7% 7.5% FTR 9.1% 23.3% 11.44% 1 Median (IQR) COP: characterization of patients, 1 Median (IQR); E/U: emergency/urgency (type of surgery) , NC/GA: Non-cardiac/genetic abnormality, PCS: previous cardiac surgery, ST 1,2/ RA 1-2: STAT 1-2 for study 1 and 2, RACH-1 1-2 for study 3 , FTR: failure to rescue , 1* : STS-CHSDB, 2* : Pediatric cardiac surgery program with limited systemic resources, 3* : Our study Discussion This study on pediatric patients undergoing CHS in a middle-income country institution revealed a higher mortality rate (7.5%) compared to the literature-reported range of 2–6% [ 4 – 6 , 9 , 11 ]. Similarly, a higher rate of complications (65%) was observed in comparison to the rates in high-income countries (39–44%) [ 11 ]. The higher mortality and complication rates can be attributed to our institution's patients being generally unhealthier (Table 5 ). Likewise, a high percentage of our patients presented low weight-for-age (44%), low weight-for-height (32%), and a significant number of the surgeries performed were emergent or urgent (40%). Given that our institution is a high-complexity service provider in a middle-income country, patients are typically referred from other institutions where they lacked specialized care to provide proper treatment. Though, before surgery, issues like late access to health services and limited access to technology and medicines can worsen patients' conditions and outcomes. We showed that the presence of postoperative complications after CHS is an independent risk factor and the primary contributor to postoperative mortality. Pasquali and colleagues reported that postoperative complications significantly alter a patient’s subsequent risk of death[ 6 ] and Polivenok reported similar findings in an institution with limited resources [ 11 ]. In our study, patients with postoperative complications were 15 times more likely to die compared to the patients that had no complications (Table 4 ). Urgent/emergent surgery was also an independent risk factor for mortality and patients were 8 times more likely to die, compared to patients with elective surgeries. Despite the common assumption that hospitals with better quality performance have lower rates of postoperative complications, multiple studies in adults indicate a weak correlation between complication rates and hospital performance [ 6 , 8 , 9 , 11 ]. Comorbidities and preoperative conditions are the primary factors associated with complications. Conversely, Pasquali et al showed that pediatric heart centers with superior performance do not necessarily exhibit a lower incidence of complications. Instead, they achieved a lower FTR rate [ 6 ]. Our study also yielded this finding, where even though our mortality rate (7.5%) and complication rate (65%) were higher compared to other studies, we were able to attain a comparable FTR rate (11%) to high-income countries' health institutions (Fig. 1 ) [ 6 , 12 ]. The most prevalent complications in our study were cardiac dysfunction, respiratory insufficiency, and multiorgan failure (Table 3 ). Cardiac dysfunction is defined by the STS-CHS database as having some of the following: tachycardia, oliguria, decreased skin perfusion, and need for increased inotropic support [ 6 ]. Tachycardia and increased inotropic support were the most common parameters that the patients presented. Also, being oliguria a criterion for cardiac dysfunction, most of the patients that presented renal failure, displayed cardiac dysfunction as well, so this likely increased the multiorgan failure rate. The STS-CHS database (version 2.50) defined respiratory insufficiency complication by 3 subgroups depending on the management, including mechanical ventilation (MV) greater than 7 days, reintubation, or tracheostomy [ 6 ]. We included all patients in these three categories in one group of complications. A considerable number of patients with ongoing CHS were critically ill, though requiring MV support for more than 7 days. Previous studies report a wide range of the most frequent complications including postoperative bleeding, cardiac dysfunction, unplanned reoperation, acute renal failure, and surgical site infection [ 11 , 13 , 14 ]. This indicates the need for protocols and improvement strategies for each institution. Mortality and complications will differ according to the population characteristics and resources available. The result of this investigation also suggests that strategies for postoperative complications and management are critical for reducing mortality. Similar recommendations were reported in the STS-CHS database study [ 6 ]. Limitations This study was carried out in a single institution with a limited number of patients. Hence, results cannot be extrapolated to other programs. Furthermore, the postoperative complications included in the study were limited to complications established in the STS-CHS database. Though, we did not capture every possible postoperative complication. However, this allowed an effective and objective comparison between studies. Conclusion FTR is an effective and comparable quality measure in healthcare institutions and is a major contributor to postoperative mortality in CHS. We obtained a comparable FTR rate to high-income countries' health institutions, despite a higher mortality and complication rate in our pediatric cardiac surgeries. Further characterization of postoperative complications across centers and strategies for complications prevention and management are essential to reduce mortality. Declarations The authors declare no disclosures or any conflict of interest. References Simsic JM, Cuadrado A, Kirshbom PM, Kanter KR. Risk adjustment for congenital heart surgery (RACHS): Is it useful in a single-center series of newborns as a predictor of outcome in a high-risk population? Congenit Heart Dis 2006;1:148–51. https://doi.org/10.1111/j.1747-0803.2006.00026.x. Thom T, Haase N, Rosamond W, Howard VJ, Rumsfeld J, American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. 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Althabe M, Ricardo Rodríguez R, Balestrini M, Charroqui A, Krynski M, Lenz AM, et al. Morbidity in congenital heart surgery in a public hospital in Argentina. Arch Argent Pediatr 2018;116:e14–8. https://doi.org/10.5546/aap.2018.eng.e14. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 01 Jan, 2024 Read the published version in Congenital Heart Disease → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2908809","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":198451225,"identity":"d4665636-7b29-4951-b81b-67b39b387cb1","order_by":0,"name":"Gustavo Cruz","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYNCDDzYMMsSoY2yAs2akMfCQpoWZhxgt8hHpzx/8bLNh4J99xvizTcJhHgb23scvGGpscGoxvJFj2NjblsYgcS7HwDgHpIXnuJkFw7E03Fpm5DA28Jw5zGDAw2OQnPsjjYdBIo3NgLHhMB4t6Q8b/0C1HLZIIEKLvESCYTNPBViLYTNDgg1IC/MDfFoMeN4YzpapSOOROMNWzNgD1MLGc4yNIQGPX+Tb0x98fGNgI8ffw7z5w48ECTl+9jbmDx/whJjBAQiNiA42IJJIwKkBaEsDFkHmD3h0jIJRMApGwcgDAFfOR0QxNQIXAAAAAElFTkSuQmCC","orcid":"","institution":"Fundación Valle del Lili","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Gustavo","middleName":"","lastName":"Cruz","suffix":""},{"id":198451227,"identity":"29bef18d-bfd0-4fe0-adae-510fbf6f86eb","order_by":1,"name":"Santiago Pedroza","email":"","orcid":"","institution":"Fundación Valle del Lili","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Santiago","middleName":"","lastName":"Pedroza","suffix":""},{"id":198451229,"identity":"757ec9b1-3d2a-4e06-b575-1df7eb9c55dd","order_by":2,"name":"Juan F. Vélez","email":"","orcid":"","institution":"Fundación Valle del Lili","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Juan","middleName":"F.","lastName":"Vélez","suffix":""},{"id":198451231,"identity":"32ee01e3-f9dc-4a54-a678-eb9de7a24145","order_by":3,"name":"Jessica Largo","email":"","orcid":"","institution":"Fundación Valle del Lili","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jessica","middleName":"","lastName":"Largo","suffix":""},{"id":198451233,"identity":"4f79673b-044d-4270-8068-5c913b6dbf41","order_by":4,"name":"Juan F. Tejada","email":"","orcid":"","institution":"Universidad Icesi","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Juan","middleName":"F.","lastName":"Tejada","suffix":""},{"id":198451236,"identity":"491cd570-484d-440a-92dc-c4c0fbf93e36","order_by":5,"name":"Jorge Humberto Mejía","email":"","orcid":"","institution":"Fundación Valle del Lili","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jorge","middleName":"Humberto","lastName":"Mejía","suffix":""}],"badges":[],"createdAt":"2023-05-08 17:29:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2908809/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2908809/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.32604/chd.2024.044244","type":"published","date":"2024-01-01T06:31:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":36925619,"identity":"8455b558-176f-4ace-8005-71edb11ad09f","added_by":"auto","created_at":"2023-05-12 03:11:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":80828,"visible":true,"origin":"","legend":"\u003cp\u003eComplication, mortality, and FTR rate in the 3 studies compared.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-2908809/v1/24bd35752c1d1e1673bbdf00.png"},{"id":56581839,"identity":"f3639e79-79a1-40a4-905f-0e61d10fa11d","added_by":"auto","created_at":"2024-05-16 06:31:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":871225,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2908809/v1/baa545fb-2604-4a32-8a22-3e6500646ac4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Failure to rescue as a quality metric in congenital heart surgeries in a high- complexity service provider institution located in a middle-income country","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe high complexity of congenital heart surgeries (CHS) is related to a higher rate of complications and mortality compared to other types of surgeries [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In addition, congenital heart disease is the leading contributor to infant mortality resulting from birth defects and at least a third of pediatric patients with CHS have reported postoperative complications [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA complication within the in-hospital context refers to an adverse event associated with an acquired disease or a health center intervention, different from the expected natural course of evolution [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These events negatively affect outcomes, increasing the length of stay, hospital costs and mortality [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Throughout the years, the rate of postoperative complications and mortality in CHS have been used to determine the quality of service of health institutions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, morbidity and mortality depend greatly on non-modifiable individual factors, independent of the quality of health service and the institution [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This can cause significant differences in complication and mortality rates between health institutions that do not necessarily mean better or worse service quality. In an analysis of the largest database of CHS in North America, the CHS database of the society of thoracic surgeons (STS-CHSDB), postoperative outcomes and associated variables were evaluated. One of the most relevant findings was that morbidity and mortality largely depend on patient preoperative factors, their health status, and the complexity level of the surgery, variables unrelated to the institutions' quality of service [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFailure to rescue (FTR), defined as the mortality of patients who experienced complications, has been an effective quality measure used in different pediatric surgical procedures [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Similarly, FTR studies have been conducted in CHS including institutions of different incomes, resources, and levels [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Our study aims to present the complications, mortality, and risk factors in pediatric patients undergoing CHS in a high-complexity University institution located in a middle-income country and compare it with other institutions that have conducted a similar study. Most of the literature regarding postoperative complications and mortality in CHS is focused on high-income countries, while there is limited knowledge about this topic in low and middle-income countries [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch3\u003eStudy Design\u003c/h3\u003e\n\u003cp\u003eA retrospective observational study was conducted in a high-complexity University hospital, La Fundaci\u0026oacute;n Valle Del Lili in Cali, Colombia. All pediatric patients (under 18 years old) undergoing any CHS between November 2019 and May 2022 were included. Patients with any oncoproliferative disease were excluded. We only analyzed the patient\u0026acute;s first cardiovascular procedure. There was no change in personnel during the study period.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eVariables\u003c/h3\u003e\n\u003cp\u003ePatient demographics, preoperative clinical status, surgery conditions, and outcomes were searched in the patient\u0026acute;s medical records. Each patient was assigned a study ID to ensure anonymity. The variables were annotated in the institution's clinical database management system by the researchers, a platform for protected data collection. For demographic variables, we identified the patients' age, sex, weight, and height. Preoperative clinical variables included risk factors and established pathologies including low weight for age, low weight for height, prematurity, history of cardiac surgeries, number of cardiac surgeries in the actual hospitalization, and history of pulmonary, hepatic, neurologic, or endocrine disease. For the surgery condition variables, we established the diagnosis, the type of surgery performed, the RACHS-1, and the level of urgency (elective or urgent/emergency) for each procedure.\u003c/p\u003e\n\u003cp\u003eThe main outcomes evaluated in the study were complication, mortality, and FTR rates. The definition of each complication was based on the classification established in the STS-CHS database (version 2.50) [\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e]. We included cardiovascular (cardiac dysfunction, cardiac failure, cardiac arrest, arrhythmias, pericardial effusion, systemic vein obstruction, pulmonary vein obstruction), respiratory (respiratory insufficiency, pneumonia, pneumothorax, pleural effusion, pulmonary hypertension, chylothorax), renal (renal failure), infectious (sepsis, endocarditis), reintervention (secondary to bleeding, cardiac or non-cardiac causes, and unplanned catheterization), neurological (deficits, seizures, stroke, subdural hematoma, intraventricular hemorrhage), wound-related (dehiscence and surgical site infection), anesthetic-related, rehospitalization within 30 days, multiorgan failure and other postoperative complications. Delayed sternal closure was not included as a complication because the sternum was often left open due to institutional protocol and the patient's hemodynamic status.\u003c/p\u003e\n\u003ch3\u003eStatistical method\u003c/h3\u003e\n\u003cp\u003eAll statistical analyses were performed using R statistical software version 4.2.1 (R Foundation for Statistical Computing) through RStudio 2022.12.0. For descriptive analysis, the normality of continuous variables was evaluated using the Shapiro-Wilk test. If the assumption of normality was rejected, these variables were presented as a median and interquartile range, and if not rejected, they were presented as a mean and a standard deviation. Qualitative variables were described using absolute frequencies and percentages. Operative mortality, rate of at least one complication, and FTR rate were calculated and presented with 95% confidence intervals. Univariate and multivariate logistic regression analysis was performed with mortality as the outcome variable. For the multivariate model, variables that were statistically significant based on their p-value and confidence intervals were selected. A statistical significance level of 5% was used in all tests.\u003c/p\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003eThis study was approved by the Institutional Ethics Committee (approval number 628\u0026ndash;2022 Act No. I22-112 of November 02, 2022) following national and international recommendations for human research. In accordance with resolution 8430 of 1993, this study was considered risk-free, and the waiver of informed consent was requested and obtained.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 308 pediatric patients undergoing CHS were included. The socio-demographic information and clinical characteristics of the patients are presented in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. The median age of the participants was 0.6 years (Confidence Interval (CI) 0.2-3.0). The most common age group was infants (39.3%), followed by newborns (24.4%), toddlers (20.8%), kids (13.6%), and adolescents (1.9%). Regarding the outcomes, 201 (65%) complications occurred, 23 (7.5%) patients died, and the FTR of the entire cohort was 11.4% (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Mortality and FTR varied depending on the age group and the RACH-1 classification. Younger patients and higher RACH-1 surgeries had a strong association with mortality and FTR (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSociodemographic information and clinical characteristics of the participants.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eN\u0026thinsp;=\u0026thinsp;308\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDemographic variables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e308\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge in years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.6 (0.2, 3.0) \u003csup\u003e\u003cspan class=\"BoldItalic\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNewborns (\u0026lt;\u0026thinsp;1 month)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75 (24.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInfants (1\u0026ndash;12 months)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e121 (39.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eToddler (1\u0026ndash;5 years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e64 (20.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eKids (6\u0026ndash;13 years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e42 (13.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAdolescent (13\u0026ndash;18 years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6 (1.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSex\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e144 (46.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e164 (53.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWeight (kg)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6.0 (3.6, 12.2) \u003csup\u003e\u003cspan class=\"BoldItalic\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHeight (cm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e64.5 (51.0, 96.0) \u003csup\u003e\u003cspan class=\"BoldItalic\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePreoperative clinical status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e308\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMedical history\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePulmonary disease\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e58 (18.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNeurologic disease\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e74 (24.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHepatic disease\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15 (4.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEndocrine disease\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e36 (11.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrevious cardiac surgeries\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75 (24.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSurgeries during hospitalization\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e201 (65.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e49 (15.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e23 (7.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e35 (11.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLow weight-for-age\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e305\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e133 (43.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLow weight-for-height\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e303\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e96 (31.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePremature\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e304\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e49 (16.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSurgery conditions\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eRACHS-1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e308\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot classifiable\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e17 (5.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e94 (30.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e104 (33.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e54 (17.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e23 (7.46%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10 (3.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6 (1.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eElective\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e184 (59.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUrgent/Emergency\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e124 (40.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOutcomes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e308\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDeaths and mortality\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e23 (7.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eComplications*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e201 (65.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFailure to rescue\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11.44%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003csup\u003e \u003cspan class=\"BoldItalic\"\u003e1\u003c/span\u003e \u003c/sup\u003eMedian (IQR); \u003cstrong\u003e*\u003c/strong\u003ePatients with at least one complication.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMortality, complication, and FTR rate in different age groups and RACHS-1.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAge group\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eRACHS\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTS\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePC (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMO (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFTR (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"7\" align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;1 month\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNC\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e50,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e66,67\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e78,26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8,70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11,11\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e92,86\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10,71\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11,54\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e100,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18,18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18,18\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e80,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e40,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e50,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e100,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e100,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e100,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e80\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e78,75\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e13,75\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e16,18\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"7\" align=\"left\"\u003e\n\u003cp\u003e1\u0026ndash;12 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNC\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e27,27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e55,81\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e72,73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2,27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3,13\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e100,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e22,22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e22,22\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e71,43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14,29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e80,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e60,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e100,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e66,67\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e66,67\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e122\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e64,75\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e7,38\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e11,25\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"7\" align=\"left\"\u003e\n\u003cp\u003e1\u0026ndash;5 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNC\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e25,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4,17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e16,67\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e68,18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4,55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6,67\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e55,56\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e60,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e63\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e41,27\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e3,17\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e6,90\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"7\" align=\"left\"\u003e\n\u003cp\u003e6\u0026ndash;13 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNC\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e100,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e40,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e71,43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e85,71\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14,29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e16,67\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e38\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e60,53\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e2,63\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e4,35\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"7\" align=\"left\"\u003e\n\u003cp\u003e13\u0026ndash;18 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNC\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e100,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e20,00\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0,00\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0,00\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eRACHS-1\u003c/strong\u003e: risk adjustment for congenital cardiovascular surgeries, \u003cstrong\u003eTS\u003c/strong\u003e: total surgeries, \u003cstrong\u003ePC\u003c/strong\u003e: postoperative complications, \u003cstrong\u003eMO\u003c/strong\u003e: mortality, \u003cstrong\u003eFTR\u003c/strong\u003e: failure to rescue, \u003cstrong\u003eNC\u003c/strong\u003e: not classifiable.\u003c/p\u003e\n\u003cp\u003eIn our cohort, most of the patients who presented a postoperative complication had more than 4 complications (30%) (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). The most common complications were cardiac dysfunction (33%), respiratory insufficiency (30%), pleural effusion (24%), and multiorgan failure (22%) (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSpectrum of postoperative complications\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eComplications\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eN\u0026thinsp;=\u0026thinsp;308\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumber of complications per patient\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e109 (35.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21 (6.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33 (10.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29 (9.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23 (7.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e93 (30.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCardiovascular\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCardiac disfunction\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e100 (32.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCardiac failure\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41 (13.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eArrhythmias\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45 (14.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCardiac arrest\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36 (11.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePulmonary vein obstruction\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9 (2.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePericardial effusion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9 (2.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSystemic vein obstruction\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (2.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePulmonary\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRespiratory insufficiency\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e91 (29.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePleural effusion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e75 (24.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePulmonary hypertension\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56 (18.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePneumonia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e47 (12.01%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePneumothorax\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28 (9.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChylothorax\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 (4.22%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eInfectious\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSepsis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36 (11.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEndocarditis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 (1.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eReintervention\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCardiac\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e63 (20.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon-cardiac causes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40 (12.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSecondary to bleeding\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21 (6.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUnplanned catheterization\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21 (6.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNeurological\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSubdural bleed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19 (6.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDeficit of neurologic function\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29 (9.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSeizures\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19 (6.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHematoma\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (2.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStroke\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 (2.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIntraventricular hemorrhage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (1.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eWound-related\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSurgical site infection\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15 (4.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDehiscence\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11 (3.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOther\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMultiorgan failure\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e67 13\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRenal failure\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e52 (16.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOther\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27 (8.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAnesthetic-related\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23 (7.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRehospitalization within 30 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20 (6.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u0026nbsp;Median (IQR); n (%)\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eWithin the univariate analysis, the variables of a postoperative complication (OR 14.88, CI 3.06-268.37, p\u0026thinsp;=\u0026thinsp;0.009), age (OR 0.79, CI 0.57\u0026ndash;0.96, p\u0026thinsp;=\u0026thinsp;0.068), and urgent/emergent surgery (OR 8.14, CI 2.97\u0026ndash;28.66, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were the most significant in predicting mortality (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). Therefore, these three variables were included in the multivariate analysis, finding that both the presence of a complication and urgent/emergent surgery were independent risk factors for death. Age was a protective factor, given that the OR was less than 1, though a higher age was associated with a lower risk of mortality (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). This age-mortality association was also evidenced in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eUnivariate and multivariate analysis for prediction of postoperative mortality\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOR, CI, p value\u003c/p\u003e\n\u003cp\u003e(univariate)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOR, CI, p value\u003c/p\u003e\n\u003cp\u003e(multivariate)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePO complication\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14.88, 3.06-268.37, p\u0026thinsp;=\u0026thinsp;0.009)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.92 (1.76-162.87, p\u0026thinsp;=\u0026thinsp;0.036)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge (years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.79, 0.57\u0026ndash;0.96, p\u0026thinsp;=\u0026thinsp;0.068\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.90 (0.69\u0026ndash;1.06, p\u0026thinsp;=\u0026thinsp;0.316)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUrgent/emergent surgery\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.14, 2.97\u0026ndash;28.66, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.01 (1.75\u0026ndash;18.11, p\u0026thinsp;=\u0026thinsp;0.006)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLow weight-for-age\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.99, 0.41\u0026ndash;2.34, p\u0026thinsp;=\u0026thinsp;0.990\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"1\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLow weight-for-height\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.25, 0.49\u0026ndash;3.04, p\u0026thinsp;=\u0026thinsp;0.625\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"1\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePremature\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.25, 0.49\u0026ndash;3.04, p\u0026thinsp;=\u0026thinsp;0.625\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"1\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrevious cardiac surgeries\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.63, 0.18\u0026ndash;1.74, p\u0026thinsp;=\u0026thinsp;0.413\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"1\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e: odds ratio,\u0026nbsp;\u003cstrong\u003eCI\u003c/strong\u003e: confidence interval,\u0026nbsp;\u003cstrong\u003ePO\u003c/strong\u003e: postoperative\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eWe compared our results with 2 similar studies: the STS-CHSDB (study 1)[\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e] and the Pediatric cardiac surgery program with limited systemic resources (study 2) [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]. In general, our patients were younger, and smaller, presented a significantly higher complication rate, and more urgent/emergent surgeries were performed. The mortality rate resulted in 3.7% in study 1 and 23.4% in study 2. On the other hand, FTR resulted in 9.1%, and 23.3% respectively (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003ePatient characteristics, Mortality, and FTR in studies 1, 2, and 3.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eCOP\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eStudies\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e1* n\u0026thinsp;=\u0026thinsp;40,930\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2* n\u0026thinsp;=\u0026thinsp;296\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e3* = 308\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWeight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.7 (3.9\u0026ndash;14.7)\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.0 (3.9\u0026ndash;14.5)\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.0 (3.6, 12.2)\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.58 (0.15\u0026ndash;3.6)\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.76 (0.13\u0026ndash;2.9)\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.6 (0.2, 3.0)\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;1 month\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u0026ndash;12 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eE/U\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNC/GA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eST 1,2/ RA 1\u0026ndash;2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e58%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e64.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u0026thinsp;\u0026ge;\u0026thinsp;complication\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e65.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMortality\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFTR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.44%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u0026nbsp;Median (IQR)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCOP: \u003c/strong\u003echaracterization of patients, \u003cstrong\u003e\u003cem\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003eMedian (IQR); \u003cstrong\u003eE/U:\u003c/strong\u003e emergency/urgency (type of surgery)\u003cstrong\u003e, NC/GA: \u003c/strong\u003eNon-cardiac/genetic abnormality, \u003cstrong\u003ePCS:\u003c/strong\u003e previous cardiac surgery, \u003cstrong\u003eST 1,2/ RA 1-2: \u003c/strong\u003eSTAT 1-2 for study 1 and 2, RACH-1 1-2 for study 3\u003cstrong\u003e, FTR: \u003c/strong\u003efailure to rescue\u003cstrong\u003e, 1*\u003c/strong\u003e: STS-CHSDB, \u003cstrong\u003e2*\u003c/strong\u003e: Pediatric cardiac surgery program with limited systemic resources, \u003cstrong\u003e3*\u003c/strong\u003e: Our study\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study on pediatric patients undergoing CHS in a middle-income country institution revealed a higher mortality rate (7.5%) compared to the literature-reported range of 2\u0026ndash;6% [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Similarly, a higher rate of complications (65%) was observed in comparison to the rates in high-income countries (39\u0026ndash;44%) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The higher mortality and complication rates can be attributed to our institution's patients being generally unhealthier (Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Likewise, a high percentage of our patients presented low weight-for-age (44%), low weight-for-height (32%), and a significant number of the surgeries performed were emergent or urgent (40%). Given that our institution is a high-complexity service provider in a middle-income country, patients are typically referred from other institutions where they lacked specialized care to provide proper treatment. Though, before surgery, issues like late access to health services and limited access to technology and medicines can worsen patients' conditions and outcomes.\u003c/p\u003e \u003cp\u003eWe showed that the presence of postoperative complications after CHS is an independent risk factor and the primary contributor to postoperative mortality. Pasquali and colleagues reported that postoperative complications significantly alter a patient\u0026rsquo;s subsequent risk of death[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and Polivenok reported similar findings in an institution with limited resources [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In our study, patients with postoperative complications were 15 times more likely to die compared to the patients that had no complications (Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Urgent/emergent surgery was also an independent risk factor for mortality and patients were 8 times more likely to die, compared to patients with elective surgeries.\u003c/p\u003e \u003cp\u003eDespite the common assumption that hospitals with better quality performance have lower rates of postoperative complications, multiple studies in adults indicate a weak correlation between complication rates and hospital performance [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Comorbidities and preoperative conditions are the primary factors associated with complications. Conversely, Pasquali et al showed that pediatric heart centers with superior performance do not necessarily exhibit a lower incidence of complications. Instead, they achieved a lower FTR rate [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Our study also yielded this finding, where even though our mortality rate (7.5%) and complication rate (65%) were higher compared to other studies, we were able to attain a comparable FTR rate (11%) to high-income countries' health institutions (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe most prevalent complications in our study were cardiac dysfunction, respiratory insufficiency, and multiorgan failure (Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Cardiac dysfunction is defined by the STS-CHS database as having some of the following: tachycardia, oliguria, decreased skin perfusion, and need for increased inotropic support [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Tachycardia and increased inotropic support were the most common parameters that the patients presented. Also, being oliguria a criterion for cardiac dysfunction, most of the patients that presented renal failure, displayed cardiac dysfunction as well, so this likely increased the multiorgan failure rate. The STS-CHS database (version 2.50) defined respiratory insufficiency complication by 3 subgroups depending on the management, including mechanical ventilation (MV) greater than 7 days, reintubation, or tracheostomy [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. We included all patients in these three categories in one group of complications. A considerable number of patients with ongoing CHS were critically ill, though requiring MV support for more than 7 days.\u003c/p\u003e \u003cp\u003ePrevious studies report a wide range of the most frequent complications including postoperative bleeding, cardiac dysfunction, unplanned reoperation, acute renal failure, and surgical site infection [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This indicates the need for protocols and improvement strategies for each institution. Mortality and complications will differ according to the population characteristics and resources available. The result of this investigation also suggests that strategies for postoperative complications and management are critical for reducing mortality. Similar recommendations were reported in the STS-CHS database study [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThis study was carried out in a single institution with a limited number of patients. Hence, results cannot be extrapolated to other programs. Furthermore, the postoperative complications included in the study were limited to complications established in the STS-CHS database. Though, we did not capture every possible postoperative complication. However, this allowed an effective and objective comparison between studies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFTR is an effective and comparable quality measure in healthcare institutions and is a major contributor to postoperative mortality in CHS. We obtained a comparable FTR rate to high-income countries' health institutions, despite a higher mortality and complication rate in our pediatric cardiac surgeries. Further characterization of postoperative complications across centers and strategies for complications prevention and management are essential to reduce mortality.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe authors declare no disclosures or any conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSimsic JM, Cuadrado A, Kirshbom PM, Kanter KR. Risk adjustment for congenital heart surgery (RACHS): Is it useful in a single-center series of newborns as a predictor of outcome in a high-risk population? Congenit Heart Dis 2006;1:148\u0026ndash;51. https://doi.org/10.1111/j.1747-0803.2006.00026.x.\u003c/li\u003e\n \u003cli\u003eThom T, Haase N, Rosamond W, Howard VJ, Rumsfeld J, American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006 Feb 14;113(6):e85-151. Epub 2006 Jan 11. Erratum in: Circulation. 2006 Apr 11;113(14):e696. Erratum in: Circulation. 2006 Dec 5;114(23):e630. doi: 10.1161/CIRCULATIONAHA.105.171600.\u003c/li\u003e\n \u003cli\u003eJacobs JP, Jacobs ML, Mavroudis C, Maruszewski B, Tchervenkov CI, Lacour-Gayet FG, et al. What is Operative Morbidity? Defining Complications in a Surgical Registry Database. Ann Thorac Surg 2007;84:1416\u0026ndash;21. https://doi.org/10.1016/j.athoracsur.2007.07.085.\u003c/li\u003e\n \u003cli\u003ePortuondo JI, Shah SR, Singh H, Massarweh NN. Failure to Rescue as a Surgical Quality Indicator: Current Concepts and Future Directions for Improving Surgical Outcomes. Anesthesiology 2019;131:426\u0026ndash;37. https://doi.org/10.1097/ALN.0000000000002602.\u003c/li\u003e\n \u003cli\u003eMa LW, Hatchimonji JS, Kaufman EJ, Sharoky CE, Smith BP, Holena DN. Failure to rescue as a center-level metric in pediatric trauma. Surgery (United States) 2019;165:1116\u0026ndash;21. https://doi.org/10.1016/j.surg.2019.03.004.\u003c/li\u003e\n \u003cli\u003ePasquali SK, He X, Jacobs JP, Jacobs ML, O\u0026rsquo;Brien SM, Gaynor JW. Evaluation of failure to rescue as a quality metric in pediatric heart surgery: An analysis of the STS congenital heart surgery database. Annals of Thoracic Surgery 2012;94:573\u0026ndash;80. https://doi.org/10.1016/j.athoracsur.2012.03.065.\u003c/li\u003e\n \u003cli\u003eChan T, Lion KC, Mangione-Smith R. Racial disparities in failure-to-rescue among children undergoing congenital heart surgery. Journal of Pediatrics 2015;166:812-818.e4. https://doi.org/10.1016/j.jpeds.2014.11.020.\u003c/li\u003e\n \u003cli\u003ePasquali SK, Li JS, Burstein DS, Sheng S, O\u0026rsquo;Brien SM, Jacobs ML, et al. Association of center volume with mortality and complications in pediatric heart surgery. Pediatrics 2012;129. https://doi.org/10.1542/peds.2011-1188.\u003c/li\u003e\n \u003cli\u003eJacobs JP, O\u0026rsquo;Brien SM, Pasquali SK, Jacobs ML, Lacour-Gayet FG, Tchervenkov CI, et al. Variation in outcomes for benchmark operations: An analysis of the society of thoracic surgeons congenital heart surgery database. Annals of Thoracic Surgery 2011;92:2184\u0026ndash;92. https://doi.org/10.1016/j.athoracsur.2011.06.008.\u003c/li\u003e\n \u003cli\u003eJenkins KJ, Gauvreau K. Center-specific differences in mortality: Preliminary analyses using the risk adjustment in congenital heart surgery (RACHS-1) method. Journal of Thoracic and Cardiovascular Surgery 2002;124:97\u0026ndash;104. https://doi.org/10.1067/mtc.2002.122311.\u003c/li\u003e\n \u003cli\u003ePolivenok I v., Novick WM, Pyetkov A v., Cardarelli M. Perioperative complications in a paediatric cardiac surgery program with limited systemic resources. Cardiol Young 2020;30:1659\u0026ndash;65. https://doi.org/10.1017/S1047951120002486.\u003c/li\u003e\n \u003cli\u003eWallen TJ, Fults M, Fariha NJ, Le M, Blenden R, Soto R. Failure to Rescue in Humanitarian Congenital Cardiac Surgery. Annals of Thoracic Surgery, vol. 109, Elsevier Inc.; 2020, p. 1475\u0026ndash;9. https://doi.org/10.1016/j.athoracsur.2019.09.022.\u003c/li\u003e\n \u003cli\u003eAgarwal HS, Wolfram KB, Saville BR, Donahue BS, Bichell DP. Postoperative complications and association with outcomes in pediatric cardiac surgery. Journal of Thoracic and Cardiovascular Surgery 2014;148. https://doi.org/10.1016/j.jtcvs.2013.10.031.\u003c/li\u003e\n \u003cli\u003eAlthabe M, Ricardo Rodr\u0026iacute;guez R, Balestrini M, Charroqui A, Krynski M, Lenz AM, et al. Morbidity in congenital heart surgery in a public hospital in Argentina. Arch Argent Pediatr 2018;116:e14\u0026ndash;8. https://doi.org/10.5546/aap.2018.eng.e14.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Congenital heart surgery, complication, mortality, failure to rescue, quality metric","lastPublishedDoi":"10.21203/rs.3.rs-2908809/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2908809/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFailure to rescue has been an effective quality metric in congenital heart surgery. Conversely, morbidity and mortality depend greatly on non-modifiable individual factors and have a weak correlation with better-quality performance. We aim to measure the complications, mortality, and risk factors in pediatric patients undergoing congenital heart surgery in a high-complexity institution located in a low-income country and compare it with other institutions that have conducted a similar study.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA retrospective observational study was conducted in a high-complexity service provider institution, in Cali, Colombia. All pediatric patients undergoing any congenital heart surgery between 2019 and 2022 were included. The main outcomes evaluated in the study were complication, mortality, and failure to rescue rate. Univariate and multivariate logistic regression analysis was performed with mortality as the outcome variable.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWe evaluated 308 congenital heart surgeries. Regarding the outcomes, 201 (65%) complications occurred, 23 (7.5%) patients died, and the FTR of the entire cohort was 11.4%. The presence of a postoperative complication (OR 14.88, CI 3.06-268.37, p\u0026thinsp;=\u0026thinsp;0.009), age (OR 0.79, CI 0.57\u0026ndash;0.96, p\u0026thinsp;=\u0026thinsp;0.068), and urgent/emergent surgery (OR 8.14, CI 2.97\u0026ndash;28.66, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were the most significant variables in predicting mortality.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFailure to rescue is an effective and comparable quality measure in healthcare institutions and is the major contributor to postoperative mortality in congenital heart surgeries. Despite our higher mortality and complication rate, we obtained a comparable failure to rescue rate to high-income countries' health institutions.\u003c/p\u003e","manuscriptTitle":"Failure to rescue as a quality metric in congenital heart surgeries in a high- complexity service provider institution located in a middle-income country","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-05-11 21:30:32","doi":"10.21203/rs.3.rs-2908809/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3d0bb17e-f0d0-415a-9050-4c0a8335aae1","owner":[],"postedDate":"May 11th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-05-16T06:31:50+00:00","versionOfRecord":{"articleIdentity":"rs-2908809","link":"https://doi.org/10.32604/chd.2024.044244","journal":{"identity":"congenital-heart-disease","isVorOnly":true,"title":"Congenital Heart Disease"},"publishedOn":"2024-01-01 06:31:50","publishedOnDateReadable":"January 1st, 2024"},"versionCreatedAt":"2023-05-11 21:30:32","video":"","vorDoi":"10.32604/chd.2024.044244","vorDoiUrl":"https://doi.org/10.32604/chd.2024.044244","workflowStages":[]},"version":"v1","identity":"rs-2908809","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2908809","identity":"rs-2908809","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}