Nilay Patel1, Juan Viles-Gonzalez2, Kanishk Agnihotri1, Shilpkumar Arora3, Nileshkumar J Patel4, Ekta Aneja5, Mahek Shah6, Apurva O Badheka7, Naga Venkata Pothineni8, Krishna Kancharla9, Siva Mulpuru9, Peter A Noseworthy9, Fred Kusumoto9, Yong Mei Cha9, Abhishek J Deshmukh9. 1. Internal Medicine Department, Saint Peter s University Hospital, New Brunswick, New Jersey. 2. Cardiovascular Disease, Tulane University School of Medicine, New Orleans, Louisiana. 3. Internal Medicine Department, Mount Sinai St Luke's Roosevelt Hospital, New York, New York. 4. Cardiovascular Department, University of Miami Miller School of Medicine, Miami, Florida. 5. Internal Medicine Department, Saint Barnabas Medical Center, Bronx, New York. 6. Cardiovascular Department, Lehigh Valley Healthcare Network, Allentown, Pennsylvania. 7. Cardiovascular Department, The Everett Clinic, Everett, Washington. 8. Cardiovascular Department, University of Arkansas for Medical Sciences, Little Rock, Arkansas. 9. Clinical Cardiac Electrophysiology Program, Mayo Clinic College of Medicine, Rochester, Minnesota.
Abstract
BACKGROUND: The utilization of cardiac resynchronization therapy defibrillator (CRT-D) has increased significantly, since its initial approval for use in selected patients with heart failure. Limited data exist as for current trends in implant-related in-hospital complications and cost utilization. The aim of our study was to examine in-hospital complication rates associated with CRT-D and their trends over the last decade. METHODS AND RESULTS: Using the Nationwide Inpatient Sample, we estimated 378 248 CRT-D procedures from 2003 to 2012. We investigated common complications, including mechanical, cardiovascular, pericardial complications (hemopericardium, cardiac tamponade, or pericardiocentesis), pneumothorax, stroke, vascular complications (consisting of hemorrhage/hematoma, incidents requiring surgical repair, and accidental arterial puncture), and in-hospital deaths described with CRT-D, defining them by the validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code. Mechanical complications (5.9%) were the commonest, followed by cardiovascular (3.6%), respiratory failure (2.4%), and pneumothorax (1.5%). Age (≥65 years), female gender (OR, 95% CI; P value) (1.08, 1.03-1.13; 0.001), and the Charlson score ≥3 (1.52, 1.45-1.60; <0.001) were significantly associated with increased mortality/complications. CONCLUSIONS: The overall complication rate in patients undergoing CRT-D has been increasing in the last decade. Age (≥65), female sex, and the Charlson score ≥3 were associated with higher complications. In patients who underwent CRT-D implantation, postoperative complications were associated with significant increases in cost.
BACKGROUND: The utilization of cardiac resynchronization therapy defibrillator (CRT-D) has increased significantly, since its initial approval for use in selected patients with heart failure. Limited data exist as for current trends in implant-related in-hospital complications and cost utilization. The aim of our study was to examine in-hospital complication rates associated with CRT-D and their trends over the last decade. METHODS AND RESULTS: Using the Nationwide Inpatient Sample, we estimated 378 248 CRT-D procedures from 2003 to 2012. We investigated common complications, including mechanical, cardiovascular, pericardial complications (hemopericardium, cardiac tamponade, or pericardiocentesis), pneumothorax, stroke, vascular complications (consisting of hemorrhage/hematoma, incidents requiring surgical repair, and accidental arterial puncture), and in-hospital deaths described with CRT-D, defining them by the validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code. Mechanical complications (5.9%) were the commonest, followed by cardiovascular (3.6%), respiratory failure (2.4%), and pneumothorax (1.5%). Age (≥65 years), female gender (OR, 95% CI; P value) (1.08, 1.03-1.13; 0.001), and the Charlson score ≥3 (1.52, 1.45-1.60; <0.001) were significantly associated with increased mortality/complications. CONCLUSIONS: The overall complication rate in patients undergoing CRT-D has been increasing in the last decade. Age (≥65), female sex, and the Charlson score ≥3 were associated with higher complications. In patients who underwent CRT-D implantation, postoperative complications were associated with significant increases in cost.
Authors: Douglas Darden; Pamela N Peterson; Xin Xin; Muhammad Bilal Munir; Karl E Minges; Ilan Goldenberg; Jeanne E Poole; Gregory K Feld; Ulrika Birgersdotter-Green; Jeptha P Curtis; Jonathan C Hsu Journal: Heart Rhythm O2 Date: 2022-04-02