1116. Mortality and Cost of Infection Associated with Cardiovascular Implantable Electronic Device Procedures
Session: Poster Abstract Session: Infections of Cardiovascular Devices
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • IDSA 2011_CIED cost and mortality analysis_final2.ppt.pdf (1.2 MB)
  • Background: Cardiovascular implantable electronic devices (CIED) reduce morbidity and mortality, but this benefit can be diminished by CIED infection. Although it is widely recognized that the rate of CIED infection is increasing faster than the rate of CIED implantation, there are limited published data on the mortality and cost associated with CIED infection, or the relationship of these outcomes to different CIED types.

    Methods: A retrospective cohort of 200,219 Medicare fee-for-service admissions for CIED generator implantation, replacement, or revision between January 1, 2007 and December 31, 2007, including 5,817 admissions with infection, was identified using the corresponding International Classification of Diseases 9th Revision-Clinical Modification (ICD-9-CM) codes.  Using this cohort, we defined the risk-adjusted total and incremental admission mortality, longer-term mortality, admission length of stay (LOS), and admission cost associated with CIED infection. 

    Results: Infection was associated with a significant increase in adjusted admission mortality (rate ratios=4.8-7.7; standardized rates=4.6-11.3%) and longer-term mortality (rate ratios=1.6-2.1; standardized rates=26.5%-35.1%), depending on the CIED type. Importantly, about half of the incremental longer-term mortality occurred after discharge. The adjusted LOS was significantly longer with infection (LOS mean ratios=2.5-4.0; standardized LOS=15.5-24.3 days). The standardized adjusted incremental and total admission costs with infection were $14,360-$16,498 and $28,676-$53,349, respectively, depending on the CIED type. The largest incremental cost with infection was intensive care, which accounted for more than 40% of the difference. Adjusted incremental increases in longer-term mortality and cost with infection were significantly greater for pacemakers, than for implanted cardioverter-defibrillators or cardiac resynchronization therapy/defibrillator devices. 

    Conclusion: Infection associated with CIED procedures resulted in substantial incremental admission mortality and longer-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.


    Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

    Muhammad R. Sohail, MD1, Charles Henrikson, MD2, Mary Jo Braid-Forbes, MPH3, Kevin Forbes, PhD3 and Daniel Lerner, MD4, (1)Mayo School of Graduate Medical Education, Rochester, MN, (2)Cardiology, Johns Hopkins University, Baltimore, MD, (3)Braid-Forbes Health Research, Silver Spring, MD, (4)TYRX Inc., Monmouth Junction, MD

    Disclosures:

    M. R. Sohail, None

    C. Henrikson, None

    M. J. Braid-Forbes, None

    K. Forbes, None

    D. Lerner, TyRx Inc.: Employee, Salary

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