Arrhythmias & electrophysiologyResearch article
Volume–outcome analysis of in-hospital complications after cardiac implantable electronic device implantation: a 250 000-case study
- Volume-outcome analysis
- flexible generalized additive mixed model
- mandatory quality assurance data
Authors' conclusion
This study demonstrates a statistically significant association between implantation volume and complication rates across all CIED procedures, with the effect being particularly pronounced among pacemaker patients.
Study context
- Population
- All first inpatient cardiac implantable electronic device (CIED) implantations performed between 1 January 2010 and 31 December 2020, in hospitals across North Rhine-Westphalia
- Participants
- 249,118 cases
- Comparison
- Hospital implantation volume and complication rates
Main finding
As reported in the abstract
Overall complication rate
Overall complication rate
2.4%
Lead-related issues (most common)
1.5%
Further findings
Predictors of complications
- Strongest predictors: American Society of Anaesthesiologists Class 4-5, New York Heart Association Class IV, subclavian vein access, and dual-chamber pacemaker systems
- Forest plot analysis
Association between implantation volume and complications
- Significant association, particularly among pacemaker patients
- P < 0.001
- area under the curve (AUC)
- 0.7
- Relevant reduction in hospital stays and healthcare costs
Modelled 50-case annual cut-off
- Complications prevented
- ∼16%
- Patients redirected to other hospitals
- ∼16%
- Modelling
Original publication
Volume–outcome analysis of in-hospital complications after cardiac implantable electronic device implantation: a 250 000-case study. Eur Heart J Qual Care Clin Outcomes. Published 17 August 2026. doi:10.1093/ehjqcco/qcag109
Summarised from the published abstract; every number is checked against it