Variability in Complication Rates of CIED Implantation

Sep 17, 2019
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Authors:
Ranasinghe I, Labrosciano C, Horton D, et al.
Citation:
Institutional Variation in Quality of Cardiovascular Implantable Electronic Device Implantation: A Cohort Study. Ann Intern Med 2019;171:309-317.
Summary By:
Fred Morady, MD, FACC

Study Questions:

How much institutional variability is there in the rate of complications related to implantation of cardiovascular implantable electronic devices (CIEDs)?

Methods:

A hospitalization database in Australia and New Zealand was used to collect information on 81,304 patients (mean age 74.7 years) who underwent implantation of a pacemaker (n = 65,711) or implantable cardioverter-defibrillator (ICD) (n = 15,593) at 98 hospitals. The primary outcome was major CIED-related complications that occurred during the index hospitalization or within 90 days thereafter. Major complications were defined as all-cause death within 30 days of implantation, device-related reoperation, drainage of hematoma, pericardial drainage, procedure-related shock, device-related infections, venous obstruction, and pneumothorax.

Results:

The complication rate was higher for ICDs (10.0%) than for pacemakers (7.8%). Risk-adjusted complication rates between hospitals varied between 5.3% and 14.3% for ICD implantations, and between 5.4% and 12.9% for pacemaker implantations.

Conclusions:

There is substantial variability between hospitals in complications related to CIED implantation. These data suggest that clinical and policy interventions are needed to minimize the variation in complication rates between hospitals.

Perspective:

Prior studies have demonstrated that a low annual volume of CIED implants is associated with a higher risk of complications. Hospitals with volumes as low as 25 patients over 5 years were included in this study and it is surprising that the study does not provide data regarding the relationship between annual volume and complication rate. In any event, the findings of the study emphasize the need for institutional initiatives to improve the quality of care among patients undergoing CIED implants.

Keywords: Arrhythmias, Cardiac, Cardiac Surgical Procedures, Defibrillators, Implantable, Drainage, Geriatrics, Hematoma, Hospitalization, Pacemaker, Artificial, Pneumothorax, Quality of Health Care, Reoperation, Secondary Prevention, Shock


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