Predictors of Intraoperative Echocardiography: Analysis of The Society of Thoracic Surgeons Database

Key Points

  • In this population-based, cross-sectional study of 1,973,655 patients undergoing isolated CABG or valve surgery, the use of intraoperative transesophageal echocardiography (TEE) varied substantially according to hospital and by individual surgeon.

  • Generalized linear mixed model (GLMM) analyses demonstrated that provider (eg, hospital or surgeon) practice pattern was far more predictive of intraoperative TEE use than any patient-level factor, surgical volume, or geographic location.

  • The median odds of intraoperative TEE use between two identical patients undergoing surgery at two randomly-selected hospitals (each with the same surgical volume and within the same geographic region) varied by 5-fold in valve surgery and 10-fold in isolated CABG.

Figure 1: Variation in Intraoperative TEE for Isolated CABG or Cardiac Valve Surgery Among Hospitals

Proportion of isolated CABG surgeries (orange bars) and valve surgeries (grey bars) performed with intraoperative TEE among 1,208 hospitals.

Figure 2: Variation of Intraoperative TEE in Isolated CABG or Cardiac Valve Surgery Among Individual Surgeons

Proportion of isolated CABG surgeries (orange bars) and valve surgeries (grey bars) performed with intraoperative TEE among 3,307 surgeons.

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