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

PURPOSE: This study characterized nationwide trends, demographic distributions, and regional disparities in cardiac anesthesia and intraoperative transesophageal echocardiography (ITEE) in Japan. METHODS: We conducted a retrospective observational study using the National Database of Health Insurance Claims (NDB) Open Data Japan (2019-2023). Cardiac anesthesia was defined using reimbursement codes for cardiac or thoracic great-vessel surgery requiring cardiopulmonary bypass. ITEE was evaluated using add-on claims classified into two categories: ITEE for cardiac/non-cardiac surgeries, and ITEE for percutaneous interventions. Trends were assessed using linear and Poisson regression models. Age- and sex-specific distributions and regional disparities (Gini coefficients) were assessed. RESULTS: A total of 179,920 cardiac anesthesia events were identified (28.7 per 100,000 person-years), with a male predominance (male-to-female ratio, 1.6:1). Age distribution was bimodal, peaking at 0-4 and 75-79 years. Both cardiac anesthesia and ITEE use declined transiently during Japan's first coronavirus disease 2019 state of emergency in May 2020, followed by recovery in the latter half of fiscal year 2020. Age-adjusted rates of cardiac anesthesia demonstrated no significant annual change. In contrast, ITEE use increased significantly in both cardiac/non-cardiac surgeries (relative risk [RR], 1.011/year; P < 0.0001) and percutaneous interventions (RR, 1.117/year; P < 0.0001). Regional disparities in cardiac anesthesia decreased over time, with Gini coefficients declining from 0.20 to 0.15. CONCLUSION: Cardiac anesthesia remained generally stable in Japan from 2019 to 2023. Increasing ITEE, especially for percutaneous interventions, suggests evolving cardiovascular perioperative practice, although claims-based categories require cautious interpretation.