Validation of Claims Data for the Identification of Intraoperative Transesophageal Echocardiography During Cardiac Surgery

MacKay, Emily J.; Salmon, Mandy K.; Fatuzzo, Mia; Neuman, Mark D.; Desai, Nimesh D.; Groeneveld, Peter W.; Augoustides, John

doi:10.1053/j.jvca.2021.04.017

Cited by 8 publications

(4 citation statements)

References 24 publications

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“…By creating matched pairs of 2 patients (1 with TEE vs 1 without TEE) admitted to the same hospital, and operated on by the same surgeon, we reduced hospital-level, and surgeon-level, unobserved confounding that could have biased our results. Third, in this study the exposure variable of TEE was found to be a true, intraoperative TEE; an improvement on our previous that could only identify a TEE within a hospitalization . Fourth, by performing comprehensive sensitivity analyses, we were able to quantify how much residual, unobserved confounding would be required to alter the conclusions of our analyses.…”

Section: Discussionmentioning

confidence: 93%

“…Third, in this study the exposure variable of TEE was found to be a true, intraoperative TEE; an improvement on our previous that could only identify a TEE within a hospitalization. 15,16,32 Although this matched retrospective observational study cannot elucidate the exact reasons for the clinical outcomes benefit observed with intraoperative TEE, it is likely that intraoperative TEE is conferring some degree of benefit because the association persisted on the strict, within-hospital, within-surgeon matched comparisons. Diagnostic information provided by TEE, interpreted by an experienced echocardiographer-cardiologist or anesthesiologist-could identify surgical complications [5][6][7][8][9] and improve outcomes by facilitating informed intraoperative decision making by the cardiac surgeon.…”

Section: Discussionmentioning

confidence: 97%

“…Third, in this study the exposure variable of TEE was found to be a true, intraoperative TEE; an improvement on our previous that could only identify a TEE within a hospitalization. 15,16,32 Fourth, by performing comprehensive sensitivity analyses, we were able to quantify how much residual, unobserved confounding would be required to alter the conclusions of our analyses. Across all analyses, our findings indicate an JAMA Network Open | Surgery association between TEE and improved perioperative outcomes after open cardiac valve or proximal aortic surgery.…”

Section: Discussionmentioning

confidence: 99%

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Association of Intraoperative Transesophageal Echocardiography and Clinical Outcomes After Open Cardiac Valve or Proximal Aortic Surgery

et al. 2022

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IMPORTANCEIntraoperative transesophageal echocardiography (TEE) is used frequently in cardiac valve and proximal aortic surgical procedures, but there is a lack of evidence associating TEE use with improved clinical outcomes. OBJECTIVE To test the association between intraoperative TEE use and clinical outcomes following cardiac valve or proximal aortic surgery. DESIGN, SETTING, AND PARTICIPANTS This matched, retrospective cohort study used national registry data from the Society of Thoracic Surgeon (STS) Adult Cardiac Surgery Database (ACSD) to compare clinical outcomes among patients undergoing cardiac valve or proximal aortic surgery with vs without intraoperative TEE. Statistical analyses used optimal matching within propensity score calipers to conduct multiple matched comparisons including within-hospital and within-surgeon matches, a negative control outcome analysis, and sensitivity analyses. STS ACSD data encompasses more than 90% of all hospitals that perform cardiac surgery in the US. The study cohort consisted of all patients aged at least 18 years undergoing open cardiac valve repair or replacement surgery and/or proximal aortic surgery between 2011 and 2019. Statistical analysis was performed from October 2020 to April 2021. EXPOSURES The exposure was receipt of intraoperative TEE during the cardiac valve or proximal aortic surgery. MAIN OUTCOMES AND MEASURESThe primary outcome was death within 30 days of surgery.The secondary outcomes were (1) a composite outcome of stroke or 30-day mortality and (2) a composite outcome of reoperation or 30-day mortality. RESULTSOf the 872 936 patients undergoing valve or aortic surgery, 540 229 (61.89%) were male; 63 565 (7.28%) were Black and 742 384 (85.04%) were White; 711 326 (81.5%) received TEE and 161 610 (18.5%) did not receive TEE; the mean (SD) age was 65.61 years (13.17) years. After matching, intraoperative TEE was significantly associated with a lower 30-day mortality rate compared with no TEE: 3.81% vs 5.27% (odds ratio [OR], 0.69 [95% CI, 0.67-0.72]; P < .001), a lower incidence of stroke or 30-day mortality: 5.56% vs 7.01% (OR, 0.77 [95% CI, 0.74-0.79]; P < .001), and a lower incidence of reoperation or 30-day mortality: 7.18% vs 8.87% (OR, 0.78 [95% CI, 0.76-0.80]; P < .001). Results were similar across all matched comparisons (including within-hospital, withinsurgeon matched analyses) and were robust to a negative control and sensitivity analyses.CONCLUSIONS AND RELEVANCE Among adults undergoing cardiac valve or proximal aortic surgery, intraoperative TEE use was associated with improved clinical outcomes in this cohort study.These findings support routine use of TEE in these procedures.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 97%

“…Third, in this study the exposure variable of TEE was found to be a true, intraoperative TEE; an improvement on our previous that could only identify a TEE within a hospitalization. 15,16,32 Fourth, by performing comprehensive sensitivity analyses, we were able to quantify how much residual, unobserved confounding would be required to alter the conclusions of our analyses. Across all analyses, our findings indicate an JAMA Network Open | Surgery association between TEE and improved perioperative outcomes after open cardiac valve or proximal aortic surgery.…”

Section: Discussionmentioning

confidence: 99%

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Association of Intraoperative Transesophageal Echocardiography and Clinical Outcomes After Open Cardiac Valve or Proximal Aortic Surgery

et al. 2022

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“…The exposure was TOE receipt within one calendar day of the index CABG surgery date. Used in previous studies 4 , 7 , 8 , 14 and validated as being 99.87% sensitive and 100% specific for the identification of TOE, 15 the following CPT codes were used to identify TOE: 93312–5; 93317–8; 93320–1; 93325.…”

Section: Methodsmentioning

confidence: 99%

Testing clinical selection criteria for intraoperative transoesophageal echocardiography in isolated coronary artery bypass graft surgery

MacKay,

Talham,

Zhang

et al. 2024

BJA Open

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Bleeding risk from nonsteroidal anti‐inflammatory drugs after functional endoscopic sinus surgery: Analysis of the TriNetX database

Salmon,

Eide,

Kshirsagar

et al. 2023

World j. otorhinolaryngol.-head neck surg.

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ObjectivesPostoperative pain medications and aspirin before undergoing functional endoscopic sinus surgery (FESS) are managed carefully due to concern for bleeding. Little is known regarding the increase in the risk of bleeding for patients unable to stop aspirin as trials are limited in this area. We compared outcomes for patients undergoing FESS who were managed postoperatively with nonsteroidal anti‐inflammatory drugs (NSAIDs) versus opioids. We also determined the epistaxis rate for patients on aspirin at the time of surgery compared to those who were not on aspirin.Data SourceRetrospective analysis of patients undergoing FESS using the TriNetX database.MethodsPatients were propensity‐matched, and the odds of bleeding complications between the patients prescribed postoperative NSAIDs were compared to those prescribed opioids. We also compared postoperative odds of bleeding in patients unable to halt aspirin use at the time of surgery to those who were not on aspirin before surgery.ResultsA total of 51,361 patients received opioids after FESS compared to 1923 patients who received NSAIDs. After propensity matching, 1918 patients were in each group and odds of epistaxis were similar between the NSAID group and the opioid group (odds ratio [OR]: 1.32, 95% confidence interval (CI): 0.90–1.94); 7.67% of the NSAID group required rescue opioids. Patients on aspirin who were unable to hold aspirin at surgery showed bleeding rates of 14.67% compared to 9.00% in propensity‐matched controls who were not on aspirin (OR: 1.74, 95%CI: 1.20–2.51).ConclusionsNSAID use appears to be a safe alternative to opioids for patients without pre‐existing risk factors for bleeding. Patients who remained on aspirin in the week before FESS had an increased risk of postoperative epistaxis.

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Validation of Claims Data for the Identification of Intraoperative Transesophageal Echocardiography During Cardiac Surgery

Cited by 8 publications

References 24 publications

Association of Intraoperative Transesophageal Echocardiography and Clinical Outcomes After Open Cardiac Valve or Proximal Aortic Surgery

Association of Intraoperative Transesophageal Echocardiography and Clinical Outcomes After Open Cardiac Valve or Proximal Aortic Surgery

Testing clinical selection criteria for intraoperative transoesophageal echocardiography in isolated coronary artery bypass graft surgery

Bleeding risk from nonsteroidal anti‐inflammatory drugs after functional endoscopic sinus surgery: Analysis of the TriNetX database

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