• Emily J MacKay, Bo Zhang, Mark D Neuman, John G Augoustides, Nimesh D Desai, and Peter W Groeneveld.
• Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Department of Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Penn Center for Perioperative Outcomes Research and Transformation (CPORT), University of Pennsylvania, 310 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA; Penn's Cardiovascular Outcomes, Quality and Evaluative Research Center (CAVOQER), University of Pennsylvania, Philadelphia, PA, USA. Electronic address: emily.mackay@pennmedicine.upenn.edu.
• J. Cardiothorac. Vasc. Anesth. 2022 Nov 1; 36 (11): 401240214012-4021.

ObjectivesTo identify and quantify the predictors of intraoperative transesophageal echocardiography (TEE) use among the patients undergoing cardiac valve or isolated coronary artery bypass graft (CABG) surgery.DesignAn observational cohort study.SettingThis study used the Centers for Medicare and Medicaid Services administrative claims dataset of the beneficiaries undergoing valve or isolated CABG surgery between 2013 to 2015.ParticipantsAdults aged ≥65 years of age undergoing cardiac valve or isolated CABG surgery.InterventionsGeneralized linear mixed-model (GLMM) analyses were used to examine the relationship between the TEE and patient characteristics, hospital factors, and staffing differences, while accounting for clustering within hospitals. The proportion of variation in TEE use attributable to patient-level characteristics was quantified using odds ratios. Hospital-level factors and staffing differences were quantified using the median odds ratios (MOR) and interval odds ratios (IOR).Measurements And Main ResultsAmong 261,860 patients (123,702 valve procedures and 138,158 isolated CABG), the GLMM analysis demonstrated that the strongest predictor for intraoperative TEE use was the hospital where the surgery occurred (MOR for TEE of 2.57 in valve and 4.16 in isolated CABG). The TEE staffing variable reduced the previously unexplained across-hospital variability by 9% in valve and 21% in isolated CABG, and hospitals with anesthesiologist TEE staffing (versus mixed) were more likely to use TEE in both valve and CABG (MOR for TEE of 1.21 in valve and 1.84 in isolated CABG).ConclusionHospital practice was the strongest predictor for TEE use overall. In isolated CABG surgery, hospitals with anesthesiologist TEE staffing were a primary predictor for TEE use.Copyright © 2022 Elsevier Inc. All rights reserved.

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