OBJECTIVES: Transesophageal echocardiography (TEE) 3D imaging is the standard of care imaging modality for performing left atrial appendage occlusion (LAAO) procedures. TEE contraindicated patients are at a higher risk of injury. This study examines the costs and resource utilization for patients with TEE absolute contraindications versus without and who underwent TEE imaging during their LAAO admission.

METHODS: LAAO patients were identified from April 2016 through September 2022 by ICD-10 and CPT procedure codes in the Premier Healthcare Database, an all-payer US database representing 25% of inpatient stays. TEE imaging was identified by ICD-10 procedure codes, CPT codes, and hospital charge descriptions. Patients were separated into two comparable cohorts, with TEE absolute contraindications versus without, by ICD-10 diagnosis codes. Patients were excluded if they were transferred, treated at a provider that did not continuously submit data for 3-months post-discharge, and had missing data to conduct the analysis. Multivariable generalized linear regression models were used to compare patients with and without TEE contraindications adjusted for patient, hospital, and admit characteristics.

RESULTS: A total of 38,918 LAAO atrial fibrillation patients were identified who also underwent TEE imaging; 1,626 (4.2%) had an absolute contraindication to TEE. Patients with TEE contraindications had significantly higher average length of stay (LOS) (1.6 vs 1.3; p<.001), index stay costs ($28,984 vs $27,376; p=.002) and were less frequently discharged home (92.5% vs 94.3%; p=.002). Post-discharge, these patients had higher 90-day all-cause readmissions (12.6% vs 10.5%; p=.009) and average costs ($4,175 vs $3,530; p=.015) compared to those without contraindications. In-hospital mortality was similar between the two cohorts (0.12% vs 0.16%; p=0.639).

CONCLUSIONS: TEE contraindicated LAAO patients have significantly higher LOS, costs, and 90-day readmits than those without contraindications. Alternative imaging modalities should be considered to guide LAAO procedures for these patients.