Cardiovascular implantable electronic device (CIED) therapy can reduce morbidity and mortality, but this benefit can be diminished by CIED infection. Currently, there are limited published data on the mortality and cost associated with CIED infection.
We analyzed the risk-adjusted total and incremental admission mortality, long-term mortality, admission length of stay (LOS), and admission cost associated with infection in a retrospective cohort of 200 219 Medicare fee-for-service patients admitted for CIED generator implantation, replacement, or revision between January 1, 2007, and December 31, 2007.
There were a total of 5817 admissions with infection. Infection was associated with significant increases in adjusted admission mortality (rate ratios, 4.8-7.7; standardized rates, 4.6%-11.3%) and long-term mortality (rate ratios, 1.6-2.1; standardized rates, 26.5%-35.1%), depending on CIED type. Importantly, approximately half of the incremental long-term mortality occurred after discharge. The adjusted LOS was significantly longer with infection (length of stay mean ratios, 2.5-4.0; standardized length of stay, 15.5-24.3 days), depending on CIED type. The standardized adjusted incremental and total admission costs with infection were $14 360 to $16 498 and $28 676 to $53 349, respectively, depending on CIED type. The largest incremental cost with infection was intensive care, which accounted for more than 40% of the difference. Adjusted long-term mortality rate and cost ratios with infection were significantly greater for pacemakers than for implantable cardioverter/defibrillators or cardiac resynchronization therapy/defibrillator devices.
Infection associated with CIED procedures resulted in substantial incremental admission mortality and long-term mortality that varied with the CIED type and occurred, in part, after discharge. Almost half of the incremental admission cost was for intensive care.
"To our knowledge, this is the first study to examine the impact of procedure-and device-related complications on psychological morbidity in ICD patients. Previous studies have examined the influence of complications on morbidity and mortality   and the separate impacts of shock and device advisories on patient well being rather than procedure-and device-related complications, with results being mixed  . In the current study, patients experiencing a procedureor device-related complication in the first 12 months post implant reported more anxiety and ICD concerns as compared to patients without complications, while no difference was found on depression. "
[Show abstract][Hide abstract] ABSTRACT: The implantation of cardiac implantable electronic devices (CIED) to prevent sudden cardiac death, ameliorate chronic congestive heart failure, and correct bradycardia has grown rapidly in the past decade. Bacterial infection of the device hardware (pacemaker or implantable cardioverter defibrillator [ICD] pulse generator, and intravascular wires or leads), including the tissue pocket, is rising at an even faster rate. The source infection inoculation typically occurs at the time the device is implanted, revised, or when a device generator replacement occurs. This risk is clearly related to patient and procedure-specific factors, and is reviewed in the present paper. Prophylactic preoperative antibiotics, strict sterile technique, and limiting procedure times may reduce infection risk. A novel Antibacterial Envelope (AIGISRx ® , TYRX Inc., Monmouth Junction, NJ, USA) that is directly implanted with the device generator to provide site-specific therapy could significantly lower infection risk in certain high-risk cases. This may potentially reduce inpatient mortality related to endocarditis and sepsis, and lower healthcare costs related to CIED extraction and re-implantation, which can exceed $1 million per case.
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