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Background  Surgical complexity and related morbidities may affect long‐term patient quality of life ( QOL ). Aristotle Basic Complexity ( ABC ) score and Risk Adjustment in Congenital Heart Surgery ( RACHS ‐1) category stratify the complexity of pediatric cardiac operations. The purpose of this study was to examine the relationship between surgical complexity and  QOL  and to investigate other demographic and clinical variables that might explain variation in  QOL  in pediatric cardiac surgical survivors.    Methods and Results  Pediatric Cardiac Quality of Life ( PCQLI ) study participants who had undergone cardiac surgery were included. The  PCQLI  database provided sample characteristics and  QOL  scores. Surgical complexity was defined by the highest  ABC  raw score or  RACHS ‐1 category. Relationships among surgical complexity and demographic, clinical, and  QOL  variables were assessed using ordinary least squares regression. A total of 1416 patient–parent pairs were included. Although higher  ABC  scores and  RACHS ‐1 categories were associated with lower  QOL  scores ( P <0.005), correlation with  QOL  scores was poor to fair ( r =−0.10 to −0.29) for all groups. Ordinary least squares regression showed weak association with  R  2 =0.06 to  R  2 =0.28. After accounting for single‐ventricle anatomy, number of doctor visits, and time since last hospitalization, surgical complexity scores added no additional explanation to the variance in  QOL  scores.    Conclusions   ABC  scores and  RACHS ‐1 categories are useful tools for morbidity and mortality predictions prior to cardiac surgery and quality of care initiatives but are minimally helpful in predicting a child's or adolescent's long‐term  QOL  scores. Further studies are warranted to determine other predictors of  QOL  variation.

Impact of Surgical Complexity on Health‐Related Quality of Life in Congenital Heart Disease Surgical Survivors