Timing of Nonurgent Transesophageal Echocardiography and The Risk of Embolic Events Among Patients Admitted With Infective Endocarditis. A Review of the National Inpatient Sample.

In patients hospitalized for infective endocarditis (IE), timing of nonurgent transesophageal echocardiography (TEE) to reduce embolic events (EE) is unclear. In a retrospective cohort from the 2016 to 2018 combined National Inpatient Sample (NIS), Low-risk adults with IE who underwent nonurgent (>48 hours) TEE were stratified into 3 cohorts based on the timing of the first TEE: early-TEE (3-5 days), intermediate-TEE (5-7 days) and late-TEE (>7). The primary outcome was a composite of an embolic event. Each day before TEE led to 3% increased odds of composite-embolic-events (P < 0.001), 1.21-day extra LOS (P < 0.001) and 14,186 USD increased total charge (P < 0.001). Early compared to late TEE led to reduced LOS by 10 days (P < 0.001) and total cost by 102,273 USD (P < 0.001), odds reduction of 27% in embolic strokes, 21% in septic arterial embolization and 50% reduction in preoperative time (P < 0.001). Among patients hospitalized for suspected IE, the time to TEE was correlated with increased odds of all EE, prolonged preoperative time for valve surgery, LOS, and total charge. Early TEE compared to late TEE led to the largest reduction in length of stay and total cost.