Practice Pattern Variation in the Use of Transesophageal Echocardiography for Open Valve Cardiac Surgery.
Aged
Cardiac Surgical Procedures
/ methods
Echocardiography, Transesophageal
/ standards
Female
Follow-Up Studies
Guideline Adherence
Heart Valve Diseases
/ diagnosis
Heart Valve Prosthesis
Heart Valves
/ diagnostic imaging
Humans
Male
Monitoring, Intraoperative
/ methods
Practice Patterns, Physicians'
Reproducibility of Results
Retrospective Studies
aortic valve surgery
cardiovascular surgery
ethics and policy
guideline compliance and adherence
health services
intraoperative echocardiography
mitral valve surgery
transesophageal echocardiography
Journal
Journal of cardiothoracic and vascular anesthesia
ISSN: 1532-8422
Titre abrégé: J Cardiothorac Vasc Anesth
Pays: United States
ID NLM: 9110208
Informations de publication
Date de publication:
Jan 2019
Jan 2019
Historique:
received:
20
06
2018
pubmed:
4
9
2018
medline:
26
2
2019
entrez:
4
9
2018
Statut:
ppublish
Résumé
The authors sought to assess for the presence of practice variation in the use of intraoperative transesophageal echocardiography (TEE) for open cardiac valve surgery. This study was a retrospective cohort analysis. The administrative claims data used for this investigation were multi-institutional and a representative sample of commercially insured patients in the United States between 2010 and 2015. The cohort consisted of adult patients, aged 18 years or older, undergoing open mitral valve (MV) or aortic valve (AV) surgery. This was an observational analysis without interventions. Of 19,386 valve surgeries, 12,313 (64%) underwent AV replacement, 6,192 (32%) underwent MV repair or replacement, and 881 (<5%) underwent both MV and AV surgery. The overall rate of intraoperative TEE was 82% (95% confidence interval [CI]: 81%-82%), less frequently observed in AV procedures compared to MV or combined MV-AV procedures (80% v 85%, p < 0.001). Rates of intraoperative TEE claims varied markedly across U.S. states. After adjustment, the relative odds of an intraoperative TEE claim ranged across states from 0.26 (Louisiana, 95% CI: 0.18-0.36; p < 0.001) to 2.10 (North Carolina, 95% CI: 1.57-2.82; p < 0.001). Among adult patients undergoing open AV or MV surgery in the United States, 82% had a claim for an intraoperative TEE with marked variability across U.S. states. Increasing adherence to intraoperative TEE guidelines for valve surgery may represent an unrecognized opportunity to improve the quality of cardiac surgical care.
Identifiants
pubmed: 30174265
pii: S1053-0770(18)30591-3
doi: 10.1053/j.jvca.2018.07.040
pmc: PMC6310636
mid: NIHMS1502536
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
118-133Subventions
Organisme : NHLBI NIH HHS
ID : T32 HL098054
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.
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