Arrhythmias & electrophysiology
Cardiovascular implantable electronic device infections requiring extraction: A national analysis of contemporary trends, clinical predictors, and economic burden, 2016–2022
Authors' conclusion
In this contemporary, nationally representative International Classification of Diseases, 10th Revision era cohort, the CIED infection rate requiring extraction remained low and stable at 0.024%, yet these events carried outsized clinical and economic consequences. Nearly 70% of infections were managed without same-admission reimplantation and occurred predominantly in patients with substantial multimorbidity, delineating a large, previously underrecognized population. Methicillin-resistant S aureus infections nearly doubled in-hospital mortality, whereas methicillin-susceptible S aureus, despite being more prevalent, was not independently associated with excess adjusted mortality. Infection-related hospitalization costs increased by almost 30% and rose 1.6-fold faster than costs for uncomplicated CIED implantations, indicating that CIED infections consume a disproportionate and accelerating share of healthcare resources.
Study context
- Population
- Adult US hospitalizations (2016–2022) with cardiovascular implantable electronic device (CIED)-related infection requiring device removalCIED infection hospitalizations requiring device removal, among ≈1.2 million CIED implantation hospitalizations
- Participants
- 58,880 hospitalizations
- Exposure
- same-admission reimplantation vs those without same-admission reimplantation
Methodological detailssurvey-weighted analyses, multivariable survey-logistic regression
- Survey-weighted analyses
- Multivariable survey-logistic regression
Main finding
As reported in the abstract
Annual rate
0.024%
Observational data: associations, not effects.
Further findings
| Outcome | CIED infection with same-admission reimplantation | CIED infection without same-admission reimplantation |
|---|---|---|
| Share of infections by reimplantation strategy · same-admission reimplantation declined over time | 31.2% | increased to 71.4% |
- Share of infections by reimplantation strategy: both P for trend = .0006
Predictors of infection
- Congestive heart failure, atrial fibrillation, autoimmune disease, malnutrition, obesity, and peripheral arterial disease were independently associated with infection
- Female sex was protective
Microbiology and organism-specific in-hospital mortality
- Staphylococcal species coded
- 38.8%
- Methicillin-resistant Staphylococcus aureus nearly doubled in-hospital mortality
- Methicillin-susceptible S aureus not independently associated with excess adjusted mortality
Adjusted in-hospital mortality for CIED infection hospitalizations
- Increased from
- 4.6%
- To
- 6.0%
Inflation-adjusted mean costs for infection admissions
- Increase
- 28.5%
Original publication
Summarised from the published abstract; every number is checked against it