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August 19, 2026Journal of AnesthesiaOpen Access

Nationwide trends in cardiac anesthesia requiring cardiopulmonary bypass and intraoperative transesophageal echocardiography use in Japan: a claims-based analysis, 2019–2023

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Key result

ITEE use for percutaneous interventions increases ~12% annually despite stable overall cardiac anesthesia rates.

  • RR 1.117
  • 95% CI 1.108-1.126
  • P<0.0001
  • n=179,920

Why the study?

Nationwide trends, demographic distributions, and regional disparities in cardiac anesthesia and intraoperative transesophageal echocardiography in Japan were not well characterized.

Population

179,920 cardiac anesthesia events in Japan

Design

Retrospective observational study

Authors

MKMasamitsu KidoYNYoshinobu NakayamaLYLuying Yan

Discussion

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Overview

Reveals regional disparities in cardiac anesthesia and ITEE use in Japan; leaves open whether these reflect inequities needing targeted investigation.

Key Points

  • To characterize nationwide trends, demographic patterns, and regional disparities in cardiac anesthesia requiring cardiopulmonary bypass and intraoperative transesophageal echocardiography (ITEE) in Japan.
  • Conducted a retrospective observational study analyzing nationwide health insurance claims from the National Database of Health Insurance Claims Open Data Japan between 2019 and 2023 (N=179,920 cardiac anesthesia events).
  • Evaluated cardiac anesthesia requiring cardiopulmonary bypass and ITEE use (for surgeries and percutaneous interventions) using linear and Poisson regression models alongside Gini coefficients.
  • Identified 179,920 cardiac anesthesia events (28.7 per 100,000 person-years; male-to-female ratio 1.6:1) with bimodal age peaks at 0–4 and 75–79 years and stable age-adjusted rates over time.
  • ITEE utilization increased significantly over the study period for both surgical procedures (RR, 1.011/year; P < 0.0001) and percutaneous interventions (RR, 1.117/year; P < 0.0001).
  • Regional disparities in cardiac anesthesia delivery diminished nationwide, evidenced by Gini coefficients decreasing from 0.20 to 0.15.

Study Design

Type

Observational (n=179,920)

Structured PICO

P
Population
179,920 cardiac anesthesia events and over 289,000 ITEE claims from the Japanese National Database of Health Insurance Claims between 2019 and 2023.
O
Outcome
Nationwide trends, demographic distributions, and regional disparities in cardiac anesthesia and intraoperative transesophageal echocardiography (ITEE) use

Main Result

Relative Risk: 1.117 (95% CI 1.108–1.126)

p-value: p=<0.0001

Cardiac anesthesia rates remained stable in Japan from 2019 to 2023, while the use of intraoperative transesophageal echocardiography significantly increased, particularly for percutaneous structural heart interventions.

Limitations

  • Aggregated counts rather than individual-level records precluded identification of repeated events in the same patient.
  • Disease-specific, institution-level, and clinical outcome data were unavailable.
  • Selected reimbursement codes captured only procedures requiring cardiopulmonary bypass, underrepresenting off-pump and minimally invasive procedures.
  • Cardiac anesthesia and ITEE codes were not mutually nested, preventing direct denominator-compatible comparisons.
  • The internal composition of the percutaneous ITEE category could not be determined, precluding procedure-specific inference.
  • Claims-based categories require cautious interpretation
  • Cannot distinguish specific procedures within aggregated claims data
  • Suppression of low-frequency events in the NDB Open Data

Cite This Study

Kido et al. (2026) conducted an observational in Cardiac anesthesia and intraoperative transesophageal echocardiography (ITEE) use (n=179,920). Temporal trends (Fiscal years 2019-2023) vs. Previous years (annual change) was evaluated on Annual trend in age-adjusted event rates for ITEE for percutaneous interventions (RR 1.117, 95% CI 1.108-1.126, p=<0.0001). From 2019 to 2023 in Japan, age-adjusted rates of cardiac anesthesia remained stable, while ITEE use increased significantly, particularly for percutaneous interventions (RR 1.117 per year).

synapsesocial.com/papers/6a85630603308d306e2d6087https://doi.org/10.1007/s00540-026-03869-8
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