Mortality and cost associated with cardiovascular implantable electronic device infections

Muhammad R. Sohail, Charles A. Henrikson, Mary Jo Braid-Forbes, Kevin F. Forbes, Daniel J. Lerner

Research output: Contribution to journalArticle

159 Citations (Scopus)

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)1821-1828
Number of pages8
JournalArchives of Internal Medicine
Volume171
Issue number20
DOIs
StatePublished - Nov 14 2011

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Costs and Cost Analysis
Equipment and Supplies
Mortality
Infection
Length of Stay
Critical Care
Cardiac Resynchronization Therapy Devices
Fee-for-Service Plans
Defibrillators
Implantable Defibrillators
Medicare
Morbidity

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Sohail, M. R., Henrikson, C. A., Braid-Forbes, M. J., Forbes, K. F., & Lerner, D. J. (2011). Mortality and cost associated with cardiovascular implantable electronic device infections. Archives of Internal Medicine, 171(20), 1821-1828. https://doi.org/10.1001/archinternmed.2011.441

Mortality and cost associated with cardiovascular implantable electronic device infections. / Sohail, Muhammad R.; Henrikson, Charles A.; Braid-Forbes, Mary Jo; Forbes, Kevin F.; Lerner, Daniel J.

In: Archives of Internal Medicine, Vol. 171, No. 20, 14.11.2011, p. 1821-1828.

Research output: Contribution to journalArticle

Sohail, MR, Henrikson, CA, Braid-Forbes, MJ, Forbes, KF & Lerner, DJ 2011, 'Mortality and cost associated with cardiovascular implantable electronic device infections', Archives of Internal Medicine, vol. 171, no. 20, pp. 1821-1828. https://doi.org/10.1001/archinternmed.2011.441
Sohail, Muhammad R. ; Henrikson, Charles A. ; Braid-Forbes, Mary Jo ; Forbes, Kevin F. ; Lerner, Daniel J. / Mortality and cost associated with cardiovascular implantable electronic device infections. In: Archives of Internal Medicine. 2011 ; Vol. 171, No. 20. pp. 1821-1828.
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abstract = "Background: 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. Methods: 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. Results: 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. Conclusions: 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.",
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AB - Background: 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. Methods: 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. Results: 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. Conclusions: 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.

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