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Insler, J. E., Ramsingh, R. A. E., Bakhos, J. J., et al. | JAMA Surg (2025) 160(3):354-356 | Injury to internal thoracic artery to left anterior descending artery grafts in cardiac reoperations

November 29, 2025

Methods: This cohort study was a post hoc exploratory analysis evaluating the association between the Anesthesia Recovery Room Care (ARRC) intervention and mortality 18 months after surgery. The research ethics committee of the Central Adelaide Local Health Network approved the study, and the requirement for informed consent was waived based on evidence of benefit from a pilot study. The study followed the STROBE reporting guideline. Mortality data from March 1, 2021, to October 14, 2023, were obtained from the South Australian Registry of Births, Deaths and Marriages for ARRC II patients at 18 months after surgery. Survival curves were generated to compare ARRC with usual care in the propensity score-matched subgroup reported in the original analysis. Comprehensive propensity score matching was used to reduce confounding, and mortality at 18 months was compared between groups using the log-rank test. Statistical analyses were performed using R version 4.2.1.

Results: The ARRC cohort included 348 patients (median age 72 years [range, 19-97 years]; 157 women [44%] and 191 men [56%]), while the usual care cohort also included 348 patients (median age 72 years [range, 19-97 years]; 163 women [46%] and 185 men [54%]). The estimated 30-day mortality based on the National Safety and Quality Improvement Program was 1.7% in both groups. Postoperative mortality at 1, 3, 12, and 18 months was assessed. Over the 18-month follow-up, mortality was significantly lower in the ARRC group than in the usual care group (hazard ratio 0.65; 95% confidence interval 0.44-0.98; P = 0.04).

Discussion: These findings suggest that reducing early postoperative complications through the ARRC intervention is associated with lower long-term mortality. Previous observational studies have similarly demonstrated that early postoperative complications are associated with increased long-term mortality. Khuri et al. reported a three- to fivefold increase in 12-month mortality among patients experiencing any early postoperative complication. Moonesinghe et al. found that prolonged postoperative morbidity after elective surgery was associated with a hazard ratio of 3.5 for 12-month mortality. More recently, another study reported a hazard ratio of 1.9 for 12-month mortality among lower-risk patients who experienced early postoperative complications.