Arrhythmias & electrophysiologyCross-sectional study
Cardiovascular implantable electronic device infections requiring extraction: A national analysis of contemporary trends, clinical predictors, and economic burden, 2016–2022
- National analysis using the National Inpatient Sample
- survey-weighted analyses
- multivariable survey-logistic regression
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 approximately 1.2 million CIED implantation hospitalizations
- Participants
- 58,880 hospitalizations
- Exposure
- same-admission reimplantation vs those without same-admission reimplantation
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