Transesophageal Echocardiography, Mortality, and Length of Hospitalization after Cardiac Valve Surgery - 08/06/20
Abstract |
Background |
Despite recommendations regarding the use of intraoperative transesophageal echocardiography (TEE), there is no randomized evidence to support its use in cardiac valve surgery. The purpose of this study was to compare the clinical outcomes of patients undergoing open cardiac valve repair or replacement surgery with and without transesophageal echocardiographic monitoring. The hypothesis was that transesophageal echocardiographic monitoring would be associated with lower 30-day mortality and shorter length of hospitalization.
Methods |
In this observational retrospective cohort study, Medicare claims were used to test the association between perioperative TEE and 30-day all-cause mortality and length of hospitalization among patients undergoing open cardiac valve repair or replacement surgery between January 1, 2010, and October 1, 2015. Baseline characteristics were defined by inpatient and outpatient claims. Medicare death records were used to ascertain 30-day mortality. Statistical analyses included regression models and propensity score matching.
Results |
A total of 219,238 patients underwent open cardiac valve surgery, of whom 85% underwent TEE. Patients who underwent TEE were significantly older and had greater comorbidities. After adjusting for patient demographics, clinical comorbidities, surgical characteristics, and hospital factors, including annual surgical volume, the TEE group had a lower adjusted odds of 30-day mortality (odds ratio, 0.77; 95% CI, 0.73 to 0.82; P < .001), with no difference in length of hospitalization (<0.01%; 95% CI, −0.61% to 0.62%; P = .99). Results were similar across all analyses, including a propensity score–matched cohort.
Conclusions |
Transesophageal echocardiographic monitoring in cardiac valve repair or replacement surgery was associated with lower 30-day risk-adjusted mortality, without a significant increase in length of hospitalization. These findings support the use of TEE as routine practice in open cardiac valve repair or replacement surgery.
Le texte complet de cet article est disponible en PDF.Highlights |
• | There is a lack of research on TEE in open cardiac valve surgery |
• | TEE for open cardiac valve surgery is only an AHA class II recommendation |
• | This study found that TEE was associated with lower 30-day, risk-adjusted mortality |
• | This study found no difference in length of hospitalization with TEE vs without |
Keywords : Transesophageal echocardiography, Cardiovascular surgery, Health services research, Comparative effectiveness research, Outcomes research
Abbreviations : CPT, OR, TEE
Plan
This work was supported by a National Institutes of Health T-32 training grant (5T32HL098054) to Dr. MacKay. |
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Conflicts of interest: None. |
Vol 33 - N° 6
P. 756 - juin 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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