This outcome is determined based on the occurrence of 1 or more of the following events within 90 days of the surgery date:

• Death during the surgery admission or during an emergency department encounter or inpatient re-admission within 90 days of the surgery; IP disposition code (prior 2015) '11' or (2015 or later) '20' is used to identify in-hospital deaths; disposition code '20' is used to identify ED deaths.
• Post OP Myocardial Infarction (MI) defined as MI during the surgery admission that was not present at admission or an MI during an inpatient re-admission within 90 days of surgery; ICD-9-CM codes used to identify MIs: 410.xx. ICD-10-CM codes used to identify MIs: I21.0x, I21.1x, I21.2x, I21.3, I22.0, I22.1, I22.8, I22.9, I21.4, I22.2.
• Post OP Stroke defined as stroke during the surgery admission that was not present at admission or stroke during an inpatient re-admission within 90 days of surgery; ICD-9-CM codes used to identify Strokes: 997.02, 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91. ICD-10-CM codes used to identify Strokes: I63.xx, G97.31, G97.32, I97.81x, I97.82x.
• Re-Intervention defined as any cardiac surgery / intervention during the index surgery admission that occurred at least 1 day after the index surgery or a cardiac surgery / intervention during an inpatient re-admission within 90 days of surgery The following situations are considered re-interventions: Any procedure in the ICD-9-PCS range 35.xx-38.xx or ICD-10-PCS 02xxxxx that was performed using ECC (ICD-9-PCS code: 39.61, ICD-10-PCS codes: 5A1221Z) or off-pump CABG procedure (ICD-9-PCS: 36.1x, ICD-10-PCS: 0210xxx, 0211xxx, 0212xxx, 0213xxx) or TAVR (ICD-9-PCS: 35.05, 35.06, ICD-10-PCS: 02RF3xx, X2RF3xx). Any PCI (ICD-9-PCS for IP data: 36.01, 36.02, 36.05, 36.06, 36.09, 00.66; ICD-10-PCS for IP data: 02703xx, 02713xx, 02723xx, 02733xx, 02C03xx, 02C13xx, 02C23xx, 02C33xx, X2C03xx, X2C13xx, X2C23xx, X2C33xx, 02704xx, 02714xx, 02724xx, 02734xx, 02C04xx, 02C14xx, 02C24xx, 02C34xx, X2C04xx, X2C14xx, X2C24xx, X2C34xx; CPT codes for ED data for 2012 or earlier: 92980, 92981, 92982, 92983, 92984, 92995, 92996; CPT codes for ED data for 2013: 92920, 92921, 92924, 92925, 92928, 92929, 92933, 92934, 92937, 92938, 92941, 92943, 92944).

All events are weighted equally.
Only patients are included who did not leave against medical advice, who were residents of California at the time of the surgery, and who had surgery prior to 2021-10-02.