Isuru Ranasinghe1, Clementine Labrosciano2, Dennis Horton3, Anand Ganesan4, Jeptha P Curtis5, Harlan M Krumholz6, Andrew McGavigan4, Sadia Hossain7, Tracy Air2, Saranya Hariharaputhiran7. 1. Basil Hetzel Institute for Translational Research, University of Adelaide, and Central Adelaide Local Health Network, Adelaide, South Australia, Australia (I.R.). 2. University of Adelaide, Adelaide, South Australia, Australia (C.L., T.A.). 3. Basil Hetzel Institute for Translational Research, University of Adelaide, and Data to Decisions Cooperative Research Centre, Adelaide, South Australia, Australia (D.H.). 4. Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia (A.G., A.M.). 5. Yale-New Haven Hospital and Yale School of Medicine, New Haven, Connecticut (J.P.C.). 6. Yale-New Haven Hospital, Yale School of Medicine, and Yale University, New Haven, Connecticut (H.M.K.). 7. Basil Hetzel Institute for Translational Research and University of Adelaide, Adelaide, South Australia, Australia (S.H., S.H.).
Abstract
Background: Cardiovascular implantable electronic devices (CIEDs) are associated with procedure-related complications, yet little is known about variation in complication rates among institutions that may suggest disparities in care quality. Objective: To assess institutional variation in risk-standardized complication rates (RSCRs) for CIED. Design: Cohort study. Setting: 174 hospitals in Australia and New Zealand, 98 of which implanted at least 25 CIEDs during the study period. Participants: 81 304 patients older than 18 years (mean, 74.7 years [SD, 12.4]; 37.9% female) who received a new CIED (65 711 permanent pacemakers [PPMs] and 15 593 implantable cardioverter-defibrillators [ICDs]) in 2010 to 2015. Measurements: RSCRs and frequencies of major device-related complications during hospitalization or within 90 days of discharge. Results: Of the cohort, 6664 patients (8.2%) had a major complication. Although complication rates were higher for ICDs than PPMs (10.04% vs. 7.76%), 76.5% of all complications were attributable to PPMs (5098 vs. 1566 for ICDs). Among hospitals that implanted at least 25 CIEDs, the median RSCR was 8.1%; however, rates varied from 5.3% to 14.3%, with 22 hospitals identified as having RSCRs that differed significantly from the national average. Similar variation was observed when RSCRs for PPM implantation (n = 96 hospitals) (median RSCR, 7.6% [range, 5.4% to 12.9%]) were considered separately from those for ICD placement (n = 68 hospitals) (median RSCR, 9.7% [range, 6.2% to 16.9%]) and persisted when only elective procedures were assessed (n = 88 hospitals) (median RSCR, 7.4% [range, 4.7% to 13.0%]). Limitation: Possible unmeasured confounding from the use of administrative data. Conclusion: CIED complications are common and vary among hospitals, suggesting institutional variation in CIED care quality. Concerted clinical and policy interventions are needed to address CIED-related complications. These efforts should preferentially target PPMs, because most CIED complications are attributable to these devices. Primary Funding Source: The Hospitals Contribution Fund Research Foundation.
Background: Cardiovascular implantable electronic devices (CIEDs) are associated with procedure-related complications, yet little is known about variation in complication rates among institutions that may suggest disparities in care quality. Objective: To assess institutional variation in risk-standardized complication rates (RSCRs) for CIED. Design: Cohort study. Setting: 174 hospitals in Australia and New Zealand, 98 of which implanted at least 25 CIEDs during the study period. Participants: 81 304 patients older than 18 years (mean, 74.7 years [SD, 12.4]; 37.9% female) who received a new CIED (65 711 permanent pacemakers [PPMs] and 15 593 implantable cardioverter-defibrillators [ICDs]) in 2010 to 2015. Measurements: RSCRs and frequencies of major device-related complications during hospitalization or within 90 days of discharge. Results: Of the cohort, 6664 patients (8.2%) had a major complication. Although complication rates were higher for ICDs than PPMs (10.04% vs. 7.76%), 76.5% of all complications were attributable to PPMs (5098 vs. 1566 for ICDs). Among hospitals that implanted at least 25 CIEDs, the median RSCR was 8.1%; however, rates varied from 5.3% to 14.3%, with 22 hospitals identified as having RSCRs that differed significantly from the national average. Similar variation was observed when RSCRs for PPM implantation (n = 96 hospitals) (median RSCR, 7.6% [range, 5.4% to 12.9%]) were considered separately from those for ICD placement (n = 68 hospitals) (median RSCR, 9.7% [range, 6.2% to 16.9%]) and persisted when only elective procedures were assessed (n = 88 hospitals) (median RSCR, 7.4% [range, 4.7% to 13.0%]). Limitation: Possible unmeasured confounding from the use of administrative data. Conclusion: CIED complications are common and vary among hospitals, suggesting institutional variation in CIED care quality. Concerted clinical and policy interventions are needed to address CIED-related complications. These efforts should preferentially target PPMs, because most CIED complications are attributable to these devices. Primary Funding Source: The Hospitals Contribution Fund Research Foundation.
Authors: Oholi Tovia-Brodie; Moshe Rav Acha; Bernard Belhassen; Alessio Gasperetti; Marco Schiavone; Giovanni Battista Forleo; Milton E Guevara-Valdivia; David Valdeolivar Ruiz; Nicolas Lellouche; David Hamon; Davide Castagno; Matteo Bellettini; Gaetano M De Ferrari; Mikael Laredo; Jean-Baptiste Carvès; Barbara Ignatiuk; Giampaolo Pasquetto; Paolo De Filippo; Giovanni Malanchini; Behzad B Pavri; Craig Raphael; Luigi Rivetti; Roberto Mantovan; Jason Chinitz; Melissa Harding; Giuseppe Boriani; Edoardo Casali; Elaine Y Wan; Angelo Biviano; Carlos Macias; Stepan Havranek; Pietro Enea Lazzerini; Antonio M Canu; Marco Zardini; Giulio Conte; Óscar Cano; Michela Casella; Boris Rudic; Alexander Omelchenko; Nilesh Mathuria; Gaurav A Upadhyay; Asaf Danon; Arie Lorin Schwartz; Philippe Maury; Shiro Nakahara; Gustavo Goldenberg; Nicolas Schaerli; Sergiy Bereza; Angelo Auricchio; Michael Glikson; Yoav Michowitz Journal: Heart Rhythm Date: 2021-10-26 Impact factor: 6.343
Authors: Isuru Ranasinghe; Sadia Hossain; Anna Ali; Dennis Horton; Robert Jt Adams; Bernadette Aliprandi-Costa; Christina Bertilone; Gustavo Carneiro; Martin Gallagher; Steven Guthridge; Billingsley Kaambwa; Sradha Kotwal; Gerry O'Callaghan; Ian A Scott; Renuka Visvanathan; Richard J Woodman Journal: BMJ Open Date: 2020-08-20 Impact factor: 2.692