{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T11:41:03Z","timestamp":1793187663740,"version":"4.5.0"},"reference-count":56,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T00:00:00Z","timestamp":1744156800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T00:00:00Z","timestamp":1744156800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Nat Commun"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Perioperative organ injury contributes to morbidity and mortality of surgical patients. This cohort study included all elective and emergent surgeries in Germany over 4 years to address the impact of perioperative organ injuries on outcomes. We analyzed 28,350,953 cases. In-hospital mortality was 1.4% (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009393,157), and 4.4% of cases (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20091,245,898) experienced perioperative organ injury. Perioperative organ injury was associated with 9-fold higher odds of death and prolonged hospital stay by 11.2 days. Acute kidney injury had the highest incidence (2.0%) and was associated with 25.0% mortality. While delirium had the second highest incidence (1.5%), it was associated with the lowest mortality (10.8%). This was followed by acute myocardial infarction (incidence 0.6%, mortality 15.6%), stroke (incidence 0.6%, mortality 13.1%), pulmonary embolism (incidence 0.3%, mortality 20.0%), liver injury (incidence 0.1%, mortality 68.7%), and acute respiratory distress syndrome (incidence 0.1%, mortality 44.7%). These findings help prioritize interventions for preventing or treating individual types of perioperative organ injury.\n                  <\/jats:p>","DOI":"10.1038\/s41467-025-58161-2","type":"journal-article","created":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T14:30:48Z","timestamp":1744209048000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Impact of perioperative organ injury on morbidity and mortality in 28 million surgical patients"],"prefix":"10.1038","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4703-2478","authenticated-orcid":false,"given":"Felix","family":"Kork","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7902-7836","authenticated-orcid":false,"given":"Yafen","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adit A.","family":"Ginde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2898-6495","authenticated-orcid":false,"given":"Xiaoyi","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf","family":"Rossaint","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2570-3741","authenticated-orcid":false,"given":"Hongfang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex S.","family":"Evers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5676-6473","authenticated-orcid":false,"given":"Holger K.","family":"Eltzschig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,9]]},"reference":[{"key":"58161_CR1","doi-asserted-by":"publisher","first-page":"1474","DOI":"10.1097\/ALN.0000000000000022","volume":"119","author":"K Bartels","year":"2013","unstructured":"Bartels, K., Karhausen, J., Clambey, E. T., Grenz, A. & Eltzschig, H. K. Perioperative organ injury. Anesthesiology 119, 1474\u20131489 (2013).","journal-title":"Anesthesiology"},{"key":"58161_CR2","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1097\/01.anes.0000264751.31888.be","volume":"106","author":"AS Evers","year":"2007","unstructured":"Evers, A. S. & Miller, R. D. Can we get there if we don\u2019t know where we\u2019re going? Anesthesiology 106, 651\u2013652 (2007).","journal-title":"Anesthesiology"},{"key":"58161_CR3","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1213\/ANE.0b013e3181e2bf8e","volume":"112","author":"SM Lobo","year":"2011","unstructured":"Lobo, S. M. et al. Early determinants of death due to multiple organ failure after noncardiac surgery in high-risk patients. Anesth. Analg. 112, 877\u2013883 (2011).","journal-title":"Anesth. Analg."},{"key":"58161_CR4","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/S0140-6736(08)60878-8","volume":"372","author":"TG Weiser","year":"2008","unstructured":"Weiser, T. G. et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372, 139\u2013144 (2008).","journal-title":"Lancet"},{"key":"58161_CR5","doi-asserted-by":"publisher","first-page":"43","DOI":"10.3389\/fsurg.2015.00043","volume":"2","author":"GP Dobson","year":"2015","unstructured":"Dobson, G. P. Addressing the global burden of trauma in major surgery. Front. Surg. 2, 43 (2015).","journal-title":"Front. Surg."},{"key":"58161_CR6","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1001\/jama.2014.18666","volume":"313","author":"LL Leape","year":"2015","unstructured":"Leape, L. L. Hospital readmissions following surgery: turning complications into \u201ctreasures\u201d. JAMA 313, 467\u2013468 (2015).","journal-title":"JAMA"},{"key":"58161_CR7","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1001\/jama.2014.14179","volume":"313","author":"JB Dimick","year":"2015","unstructured":"Dimick, J. B. & Ghaferi, A. A. Hospital readmission as a quality measure in surgery. JAMA 313, 512\u2013513 (2015).","journal-title":"JAMA"},{"key":"58161_CR8","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.1016\/S0140-6736(12)61148-9","volume":"380","author":"RM Pearse","year":"2012","unstructured":"Pearse, R. M. et al. Mortality after surgery in Europe: a 7 day cohort study. Lancet 380, 1059\u20131065 (2012).","journal-title":"Lancet"},{"key":"58161_CR9","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1007\/s00268-008-9525-9","volume":"32","author":"PE Farmer","year":"2008","unstructured":"Farmer, P. E. & Kim, J. Y. Surgery and global health: a view from beyond the OR. World J. Surg. 32, 533\u2013536 (2008).","journal-title":"World J. Surg."},{"key":"58161_CR10","doi-asserted-by":"publisher","first-page":"e89693","DOI":"10.1371\/journal.pone.0089693","volume":"9","author":"J Rose","year":"2014","unstructured":"Rose, J., Chang, D. C., Weiser, T. G., Kassebaum, N. J. & Bickler, S. W. The role of surgery in global health: analysis of United States inpatient procedure frequency by condition using the Global Burden of Disease 2010 framework. PLoS One 9, e89693 (2014).","journal-title":"PLoS One"},{"key":"58161_CR11","doi-asserted-by":"publisher","first-page":"1730","DOI":"10.1213\/ANE.0000000000005191","volume":"131","author":"C Conrad","year":"2020","unstructured":"Conrad, C. & Eltzschig, H. K. Disease mechanisms of perioperative organ injury. Anesth. Analg. 131, 1730\u20131750 (2020).","journal-title":"Anesth. Analg."},{"key":"58161_CR12","doi-asserted-by":"publisher","first-page":"109961","DOI":"10.1016\/j.jclinane.2020.109961","volume":"66","author":"NJ Shah","year":"2020","unstructured":"Shah, N. J., Mentz, G. & Kheterpal, S. The incidence of intraoperative hypotension in moderate to high risk patients undergoing non-cardiac surgery: A retrospective multicenter observational analysis. J. Clin. Anesth. 66, 109961 (2020).","journal-title":"J. Clin. Anesth."},{"key":"58161_CR13","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1097\/00000658-199208000-00002","volume":"216","author":"EA Deitch","year":"1992","unstructured":"Deitch, E. A. Multiple organ failure. Pathophysiology and potential future therapy. Ann. Surg. 216, 117\u2013134 (1992).","journal-title":"Ann. Surg."},{"key":"58161_CR14","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1001\/archsurg.1975.01360130011001","volume":"110","author":"AE Baue","year":"1975","unstructured":"Baue, A. E. Multiple, progressive, or sequential systems failure. A syndrome of the 1970s. Arch. Surg. 110, 779\u2013781 (1975).","journal-title":"Arch. Surg."},{"key":"58161_CR15","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1213\/ANE.0000000000002288","volume":"126","author":"X Yuan","year":"2018","unstructured":"Yuan, X. et al. Targeting hypoxia signaling for perioperative organ injury. Anesth. Analg. 126, 308\u2013321 (2018).","journal-title":"Anesth. Analg."},{"key":"58161_CR16","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.bpa.2007.09.005","volume":"22","author":"DA Schwinn","year":"2008","unstructured":"Schwinn, D. A. & Podgoreanu, M. Pharmacogenomics and end-organ susceptibility to injury in the perioperative period. Best. Pract. Res. Clin. Anaesthesiol. 22, 23\u201337 (2008).","journal-title":"Best. Pract. Res. Clin. Anaesthesiol."},{"key":"58161_CR17","doi-asserted-by":"publisher","first-page":"2936","DOI":"10.1161\/CIRCULATIONAHA.108.828228","volume":"119","author":"G Landesberg","year":"2009","unstructured":"Landesberg, G., Beattie, W. S., Mosseri, M., Jaffe, A. S. & Alpert, J. S. Perioperative myocardial infarction. Circulation 119, 2936\u20132944 (2009).","journal-title":"Circulation"},{"key":"58161_CR18","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1213\/ANE.0000000000004053","volume":"128","author":"S Subramaniyan","year":"2019","unstructured":"Subramaniyan, S. & Terrando, N. Neuroinflammation and perioperative neurocognitive disorders. Anesth. Analg. 128, 781\u2013788 (2019).","journal-title":"Anesth. Analg."},{"key":"58161_CR19","doi-asserted-by":"publisher","first-page":"290","DOI":"10.5853\/jos.2019.00304","volume":"21","author":"R Al-Hader","year":"2019","unstructured":"Al-Hader, R. et al. The incidence of perioperative stroke: estimate using state and national databases and systematic review. J. Stroke 21, 290\u2013301 (2019).","journal-title":"J. Stroke"},{"key":"58161_CR20","doi-asserted-by":"crossref","unstructured":"Kaku, S. et al. Acute respiratory distress syndrome: etiology, pathogenesis, and summary on management. J. Intensive Care Med. 35, 723\u2013737 (2019).","DOI":"10.1177\/0885066619855021"},{"key":"58161_CR21","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1097\/ALN.0000000000002968","volume":"132","author":"SD Gumbert","year":"2020","unstructured":"Gumbert, S. D. et al. Perioperative Acute Kidney Injury. Anesthesiology 132, 180\u2013204 (2020).","journal-title":"Anesthesiology"},{"key":"58161_CR22","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1007\/s10620-011-1918-1","volume":"57","author":"RM Taylor","year":"2012","unstructured":"Taylor, R. M. et al. Short and long-term outcomes in patients with acute liver failure due to ischemic hepatitis. Dig. Dis. Sci. 57, 777\u2013785 (2012).","journal-title":"Dig. Dis. Sci."},{"key":"58161_CR23","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/S0140-6736(18)30696-2","volume":"392","author":"M Cecconi","year":"2018","unstructured":"Cecconi, M., Evans, L., Levy, M. & Rhodes, A. Sepsis and septic shock. Lancet 392, 75\u201387 (2018).","journal-title":"Lancet"},{"key":"58161_CR24","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.1097\/ALN.0b013e3182874686","volume":"118","author":"HK Eltzschig","year":"2013","unstructured":"Eltzschig, H. K. Targeting purinergic signaling for perioperative organ protection. Anesthesiology 118, 1001\u20131004 (2013).","journal-title":"Anesthesiology"},{"key":"58161_CR25","doi-asserted-by":"publisher","first-page":"e070941","DOI":"10.1136\/bmj-2022-070941","volume":"379","author":"DR McIlroy","year":"2022","unstructured":"McIlroy, D. R. et al. Oxygen administration during surgery and postoperative organ injury: observational cohort study. BMJ 379, e070941 (2022).","journal-title":"BMJ"},{"key":"58161_CR26","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1007\/s00101-022-01197-6","volume":"71","author":"M Lehmann","year":"2022","unstructured":"Lehmann, M., Zarbock, A. & Rossaint, J. [New aspects of perioperative organ protection]. Anaesthesiologie 71, 741\u2013749 (2022).","journal-title":"Anaesthesiologie"},{"key":"58161_CR27","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/S0140-6736(18)33139-8","volume":"393","author":"D Nepogodiev","year":"2019","unstructured":"Nepogodiev, D., Martin, J., Biccard, B., Makupe, A. & Bhangu, A. Global burden of postoperative death. Lancet 393, 401 (2019).","journal-title":"Lancet"},{"key":"58161_CR28","unstructured":"Coronavirus Resource Center, J.H.U. COVID-19 data in motion: thursday, october 15, Vol. 2020 (2020)."},{"key":"58161_CR29","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1038\/s41581-021-00418-2","volume":"17","author":"JR Prowle","year":"2021","unstructured":"Prowle, J. R. et al. Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative. Nat. Rev. Nephrol. 17, 605\u2013618 (2021).","journal-title":"Nat. Rev. Nephrol."},{"key":"58161_CR30","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1007\/s12630-020-01894-z","volume":"68","author":"FT Billings","year":"2021","unstructured":"Billings, F. T., Lopez, M. G. & Shaw, A. D. The incidence, risk, presentation, pathophysiology, treatment, and effects of perioperative acute kidney injury. Can. J. Anaesth. 68, 409\u2013422 (2021).","journal-title":"Can. J. Anaesth."},{"key":"58161_CR31","unstructured":"STARSurg Collaborative. Impact of postoperative acute kidney injury in patients undergoing major gastrointestinal surgery on 1-year survival and renal outcomes: a national multicentre cohort study. BJS Open 5, zrab134 (2021)."},{"key":"58161_CR32","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1097\/ALN.0000000000000891","volume":"123","author":"F Kork","year":"2015","unstructured":"Kork, F. et al. Minor postoperative increases of creatinine are associated with higher mortality and longer hospital length of stay in surgical patients. Anesthesiology 123, 1301\u20131311 (2015).","journal-title":"Anesthesiology"},{"key":"58161_CR33","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1097\/MCC.0b013e328336ea83","volume":"16","author":"C Beck","year":"2010","unstructured":"Beck, C., Schwartges, I. & Picker, O. Perioperative liver protection. Curr. Opin. Crit. Care 16, 142\u2013147 (2010).","journal-title":"Curr. Opin. Crit. Care"},{"key":"58161_CR34","first-page":"192","volume":"121","author":"LS Friedman","year":"2010","unstructured":"Friedman, L. S. Surgery in the patient with liver disease. Trans. Am. Clin. Climatol. Assoc. 121, 192\u2013204 (2010).","journal-title":"Trans. Am. Clin. Climatol. Assoc."},{"key":"58161_CR35","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1001\/jama.2016.0291","volume":"315","author":"G Bellani","year":"2016","unstructured":"Bellani, G. et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA 315, 788\u2013800 (2016).","journal-title":"JAMA"},{"key":"58161_CR36","doi-asserted-by":"publisher","first-page":"884","DOI":"10.1378\/chest.119.3.884","volume":"119","author":"J Milot","year":"2001","unstructured":"Milot, J. et al. Incidence and predictors of ARDS after cardiac surgery. Chest 119, 884\u2013888 (2001).","journal-title":"Chest"},{"key":"58161_CR37","doi-asserted-by":"crossref","unstructured":"Kassis, E. B., Beitler, J. R. & Talmor, D. Lung-protective sedation: moving toward a new paradigm of precision sedation. Intensive Care Med. 49, 91\u201394 (2022).","DOI":"10.1007\/s00134-022-06901-z"},{"key":"58161_CR38","doi-asserted-by":"publisher","first-page":"1260","DOI":"10.1056\/NEJMc1300259","volume":"368","author":"HK Eltzschig","year":"2013","unstructured":"Eltzschig, H. K., Sitkovsky, M. V. & Robson, S. C. Purinergic signaling during inflammation. N. Engl. J. Med. 368, 1260 (2013).","journal-title":"N. Engl. J. Med."},{"key":"58161_CR39","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1124\/pr.119.019026","volume":"72","author":"TJ Lee","year":"2020","unstructured":"Lee, T. J. et al. Strategies to modulate MicroRNA functions for the treatment of cancer or organ injury. Pharm. Rev. 72, 639\u2013667 (2020).","journal-title":"Pharm. Rev."},{"key":"58161_CR40","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1016\/S2213-2600(18)30418-1","volume":"7","author":"MA Matthay","year":"2019","unstructured":"Matthay, M. A. et al. Treatment with allogeneic mesenchymal stromal cells for moderate to severe acute respiratory distress syndrome (START study): a randomised phase 2a safety trial. Lancet Respir. Med. 7, 154\u2013162 (2019).","journal-title":"Lancet Respir. Med."},{"key":"58161_CR41","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1093\/bja\/aex238","volume":"119","author":"SG Soriano","year":"2017","unstructured":"Soriano, S. G., Vutskits, L., Jevtovic-Todorovic, V. & Hemmings, H. C. Thinking, fast and slow: highlights from the 2016 BJA seminar on anaesthetic neurotoxicity and neuroplasticity. Br. J. Anaesth. 119, 443\u2013447 (2017).","journal-title":"Br. J. Anaesth."},{"key":"58161_CR42","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1097\/01.sla.0000179621.33268.83","volume":"242","author":"SF Khuri","year":"2005","unstructured":"Khuri, S. F. et al. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann. Surg. 242, 326\u2013341 (2005).","journal-title":"Ann. Surg."},{"key":"58161_CR43","doi-asserted-by":"publisher","first-page":"1642","DOI":"10.1001\/jama.2017.4360","volume":"317","author":"PJ Devereaux","year":"2017","unstructured":"Devereaux, P. J. et al. Association of postoperative high-sensitivity troponin levels with myocardial injury and 30-day mortality among patients undergoing noncardiac surgery. JAMA 317, 1642\u20131651 (2017).","journal-title":"JAMA"},{"key":"58161_CR44","doi-asserted-by":"publisher","first-page":"2295","DOI":"10.1001\/jama.2012.5502","volume":"307","author":"PJ Devereaux","year":"2012","unstructured":"Devereaux, P. J. et al. Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery. JAMA 307, 2295\u20132304 (2012).","journal-title":"JAMA"},{"key":"58161_CR45","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1016\/j.bja.2020.02.003","volume":"124","author":"GL Ackland","year":"2020","unstructured":"Ackland, G. L., Abbott, T. E. F., Jones, T. F., Leuwer, M. & Pearse, R. M. Early elevation in plasma high-sensitivity troponin T and morbidity after elective noncardiac surgery: prospective multicentre observational cohort study. Br. J. Anaesth. 124, 535\u2013543 (2020).","journal-title":"Br. J. Anaesth."},{"key":"58161_CR46","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1213\/ANE.0000000000004567","volume":"131","author":"K Ruetzler","year":"2020","unstructured":"Ruetzler, K., Khanna, A. K. & Sessler, D. I. Myocardial injury after noncardiac surgery: preoperative, intraoperative, and postoperative aspects, implications, and directions. Anesth. Analg. 131, 173\u2013186 (2020).","journal-title":"Anesth. Analg."},{"key":"58161_CR47","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.bja.2020.08.056","volume":"126","author":"A Turan","year":"2021","unstructured":"Turan, A. et al. Association between postoperative haemoglobin and myocardial injury after noncardiac surgery: a retrospective cohort analysis. Br. J. Anaesth. 126, 94\u2013101 (2021).","journal-title":"Br. J. Anaesth."},{"key":"58161_CR48","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/j.surg.2011.07.021","volume":"151","author":"ME Semel","year":"2012","unstructured":"Semel, M. E. et al. Rates and patterns of death after surgery in the United States, 1996 and 2006. Surgery 151, 171\u2013182 (2012).","journal-title":"Surgery"},{"key":"58161_CR49","doi-asserted-by":"publisher","first-page":"1589","DOI":"10.1016\/S0140-6736(18)30001-1","volume":"391","author":"BM Biccard","year":"2018","unstructured":"Biccard, B. M. et al. Perioperative patient outcomes in the African surgical outcomes study: a 7-day prospective observational cohort study. Lancet 391, 1589\u20131598 (2018).","journal-title":"Lancet"},{"key":"58161_CR50","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1001\/jamasurg.2023.1035","volume":"158","author":"G Ludbrook","year":"2023","unstructured":"Ludbrook, G. et al. Outcomes of postoperative overnight high-acuity care in medium-risk patients undergoing elective and unplanned noncardiac surgery. JAMA Surg. 158, 701\u2013708 (2023).","journal-title":"JAMA Surg."},{"key":"58161_CR51","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1016\/j.avsg.2023.09.001","volume":"97","author":"JR Krebs","year":"2023","unstructured":"Krebs, J. R. et al. Presentation and outcomes of elective and nonelective complex endovascular repair for thoracoabdominal and juxtarenal aortic aneurysms. Ann. Vasc. Surg. 97, 248\u2013256 (2023).","journal-title":"Ann. Vasc. Surg."},{"key":"58161_CR52","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1080\/00015458.2017.1353236","volume":"118","author":"P Dony","year":"2018","unstructured":"Dony, P., Pirson, M. & Boogaerts, J. G. In- and out-hospital mortality rate in surgical patients. Acta Chir. Belg. 118, 21\u201326 (2018).","journal-title":"Acta Chir. Belg."},{"key":"58161_CR53","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.1016\/j.jtcvs.2015.10.062","volume":"151","author":"S Maximus","year":"2016","unstructured":"Maximus, S. et al. Defining operative mortality: impact on outcome reporting. J. Thorac. Cardiovasc. Surg. 151, 1101\u20131107 (2016).","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"58161_CR54","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1093\/bja\/aeu224","volume":"113","author":"SR Moonesinghe","year":"2014","unstructured":"Moonesinghe, S. R. et al. Survival after postoperative morbidity: a longitudinal observational cohort study. Br. J. Anaesth. 113, 977\u2013984 (2014).","journal-title":"Br. J. Anaesth."},{"key":"58161_CR55","doi-asserted-by":"crossref","unstructured":"Born, S. et al. Epidemiology of sepsis among children and neonates in Germany: results from an observational study based on nationwide diagnosis-related groups data between 2010 and 2016. Crit. Care Med. 49, 1049\u20131057 (2021).","DOI":"10.1097\/CCM.0000000000004919"},{"key":"58161_CR56","doi-asserted-by":"publisher","first-page":"e011402","DOI":"10.1161\/JAHA.118.011402","volume":"8","author":"B Reutersberg","year":"2019","unstructured":"Reutersberg, B. et al. Hospital incidence and in-hospital mortality of surgically and interventionally treated aortic dissections: secondary data analysis of the nationwide German diagnosis-related group statistics from 2006 to 2014. J. Am. Heart Assoc. 8, e011402 (2019).","journal-title":"J. Am. Heart Assoc."}],"container-title":["Nature Communications"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41467-025-58161-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41467-025-58161-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41467-025-58161-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:02:15Z","timestamp":1744588935000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41467-025-58161-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,9]]},"references-count":56,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["58161"],"URL":"https:\/\/doi.org\/10.1038\/s41467-025-58161-2","relation":{},"ISSN":["2041-1723"],"issn-type":[{"value":"2041-1723","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,9]]},"assertion":[{"value":"7 May 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 April 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Drs. Holger Eltzschig, Xiaoyi Yuan, and Yafen Liang received research funding through a contract between Akebia Therapeutics and UTHealth to support a clinical trial on the effect of vadadustat in hospitalized COVID-19 patients (NCT04478071). Akebia Therapeutics is not involved in conceptualization, design, data collection, analysis, the decision to publish, or the preparation of the manuscript. The remaining authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"3366"}}