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Although several studies have identified longer duration since implantation as a risk for serious complications when patients undergo extraction of cardiac implantable electronic device (CIED) systems, the association between other patient characteristics and key clinical outcomes is unclear.
Using the Nationwide Inpatient Sample (NIS), we examined the mortality associated with CIED extractions between 1998 and 2009 as identified by the ICD-9 procedural codes 37.76 or 37.77. Univariate logistic regression analysis was performed in order to identify predictors of mortality associated with these procedures.
During the 92,848,710 hospitalizations recorded in the NIS between 1998 and 2009, 33,121 extractions were performed. 584 in-hospital deaths were reported in patients who underwent extraction of a CIED during the index hospital admission (1.76%). The most powerful univariate predictor of in-hospital mortality was sepsis (odds ratio [OR] 15.15, p<0.01). Other predictors included pulmonary circulation disorders, congestive heart failure, coagulopathy and renal failure. Hypertension was associated with a reduced likelihood of in-hospital death (OR 0.65, p<0.01) (Table).
Among patients undergoing extraction of CIED systems, presence of sepsis, pulmonary circulation disorders, congestive heart failure, coagulopathy and renal failure were strongly associated with an increased risk of in-hospital mortality.
|Characteristic||Odds ratio||95% CI||P|
|Pulmonary circulation disorders||7.75||4.59–13.09||<0.01|
|Congestive heart failure||6.97||5.30–9.16||<0.01|
|Diabetes mellitus with complications||2.79||1.93–4.04||<0.01|
|Initial admission on a weekend||1.79||1.43–2.24||<0.01|
|African American race||1.61||1.20–2.18||<0.01|
|Hospital's affiliation with a medical college||1.51||1.24–1.84||<0.01|
|Lowest quartile income||1.44||1.13–1.83||<0.01|
|Peripheral vascular disease||1.38||0.96–1.97||0.08|
|Small hospital bed size||1.00||0.72–1.38||1.00|
|Elective case status||0.34||0.27–0.43||<0.01|
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias: Devices I – Identification and Avoidance of Complications Associated with Implantable Devices
Abstract Category: 8. Arrhythmias: Devices
Presentation Number: 1149-34
- 2013 American College of Cardiology Foundation