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Transesophageal Echocardiography, Acute Kidney Injury, and Length of Hospitalization Among Adults Undergoing Coronary Artery Bypass Graft Surgery. | LitMetric

Transesophageal Echocardiography, Acute Kidney Injury, and Length of Hospitalization Among Adults Undergoing Coronary Artery Bypass Graft Surgery.

J Cardiothorac Vasc Anesth

Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Penn Center for Perioperative Outcomes Research and Transformation (CPORT), University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics (LDI), University of Pennsylvania, Philadelphia, PA.

Published: March 2020

AI Article Synopsis

  • The study aimed to explore the link between transesophageal echocardiography (TEE) and the risk of acute kidney injury (AKI) and hospitalization duration in adults undergoing coronary artery bypass graft (CABG) surgery in the U.S. from 2004-2016.
  • Among 51,487 CABG surgeries analyzed, about 10.4% developed AKI, with an average hospital stay of 8.8 days; TEE use showed a slight increase in AKI risk and longer hospitalization.
  • Ultimately, TEE monitoring during CABG did not reduce AKI incidence or length of stay, suggesting the need for further research on its clinical benefits in these surgical cases.

Article Abstract

Objective: To test the association between transesophageal echocardiography (TEE) and incidence of acute kidney injury and length of hospitalization among United States adults undergoing isolated coronary artery bypass graft (CABG) surgery.

Design: This was an observational, retrospective cohort analysis.

Setting: This study used a multicenter claims dataset from a commercially insured population undergoing CABG surgery in the United States between 2004 and 2016.

Participants: Adults aged 18 years or older with continuous insurance enrollment and an absence of renal-related diagnoses before the index CABG surgery.

Interventions: Receipt of TEE within 1 calendar day of the index CABG surgery date.

Measurements And Main Results: Of 51,487 CABG surgeries, 5,361 (10.4%; [95% confidence interval [CI]: 10.1-10.7%]) developed acute kidney injury and the mean length of hospitalization was 8.8 days (95% CI: 8.7-8.8). The TEE group demonstrated a greater absolute risk difference (RD) for acute kidney injury by multiple linear regression, overall, (RD=+1.0; [95% CI: 0.4-1.5%]; p < 0.001) and among a low-risk subgroup (RD=+1.0; [95% CI: 0.4-1.6; p = 0.002), but not by instrumental variable analysis (RD=+0.9 [95% CI: -1.1 to 2.9%]; p = 0.362). The TEE group demonstrated a longer length of hospitalization by multiple linear regression, overall (+2.0%; [95% CI: 1.1-2.9%]; p < 0.001), among a low-risk subgroup (+2.2%; [95% CI: 1.2-3.2%]; p < 0.001), and by instrumental variable analysis (+10.3%; [95% CI: 7.0-13.7%]; p < 0.001).

Conclusions: TEE monitoring in CABG surgery was not associated with a lower incidence of acute kidney injury or decreased length of hospitalization. These findings highlight the importance of additional work to study the clinical effectiveness of TEE in CABG surgery.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986995PMC
http://dx.doi.org/10.1053/j.jvca.2019.08.042DOI Listing

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