Transesophageal Echocardiography, Mortality, and Length of Hospitalization after Cardiac Valve Surgery
Transesophageal Echocardiography, Mortality, and Length of Hospitalization after Cardiac Valve Surgery
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DOI：
10.1016/j.echo.2020.01.014
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发表时间：
2020-05-01
影响因子：
6.5
通讯作者：
Groeneveld, Peter W.
中科院分区：
文献类型：
--
作者：
MacKay, Emily J.;Neuman, Mark D.;Groeneveld, Peter W.
背景：尽管有关于术中经食道超声心动图(TEE)使用的建议，但没有随机证据支持其在心脏瓣膜手术中的使用。这项研究的目的是比较接受开放心脏瓣膜修复或置换手术的患者在接受和不接受经食道超声心动图监测的临床结果。假设经食道超声心动图监测将与较低的30天死亡率和较短的住院时间相关。方法：在这项观察性回顾队列研究中，使用Medicare Claims来检验在2010年1月1日至2015年10月1日期间接受心脏瓣膜修复术或置换手术的患者围手术期TEE与30天全因死亡率和住院时间之间的关系。基线特征由住院患者和门诊患者索赔来定义。医疗保险死亡记录被用来确定30天的死亡率。统计分析包括回归模型和倾向评分匹配。结果：共有219,238名患者接受了心脏瓣膜开放手术，其中85%接受了TEE。接受TEE治疗的患者年龄明显较大，并有更大的并发症。在调整了患者的人口学特征、临床并发症、手术特点和医院因素，包括每年的手术量后，TEE组调整后的30天死亡率的优势较低(优势比，0.77；95%CI，0.73至0.82；P<；.001)，住院时间没有差异(
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 (