• Emily J MacKay, Rachel M Werner, Peter W Groeneveld, Nimesh D Desai, Peter P Reese, Jacob T Gutsche, John G Augoustides, and Mark D Neuman.
• 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; Penn's Cardiovascular Outcomes, Quality, and Evaluative Research Center (CAVOQER), University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics (LDI), University of Pennsylvania, Philadelphia, PA. Electronic address: emily.mackay@pennmedicine.upenn.edu.
• J. Cardiothorac. Vasc. Anesth. 2020 Mar 1; 34 (3): 687-695.

ObjectiveTo 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.DesignThis was an observational, retrospective cohort analysis.SettingThis study used a multicenter claims dataset from a commercially insured population undergoing CABG surgery in the United States between 2004 and 2016.ParticipantsAdults aged 18 years or older with continuous insurance enrollment and an absence of renal-related diagnoses before the index CABG surgery.InterventionsReceipt of TEE within 1 calendar day of the index CABG surgery date.Measurements And Main ResultsOf 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).ConclusionsTEE 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.Copyright © 2019 Elsevier Inc. All rights reserved.

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