Abstract 16352: Temporal Trends in Mortality and Adverse Events in 24,890 Patients Undergoing Lead Extraction Over a Decade
Background: Despite the increasing number of pacemaker and defibrillator lead extractions, it is unclear whether lead extraction has become a safer procedure. We assessed the temporal trends in number of lead extractions performed and the associated rates of mortality and major adverse events (MAE) between the years of 2000 and 2011 in a large cohort of patients based on an administrative dataset.
Methods: Hospital records were obtained from the California state agency for the years 2000-2011. Admissions including the ICD-9 CM procedure codes 37.75, 37.76 or 37.77 (lead extraction) were analyzed. MAE included cardiac tamponade, hemothorax and emergent cardiac surgery. The rates of in-hospital MAE and death were estimated using univariate and multivariate binomial mixed effects model with random effects terms for hospital, state and fixed effect terms for demographics and comorbid conditions.
Results: 24,890 hospital discharges included the diagnosis lead extraction (Age 43.2 ± 0.14, male 40.9%, white 53.3%). Between 2000 to 2011 there was an increase in the number of lead extractions (2000: n = 1661; 2011: n = 2106) with decrease in the number of hospitals performing lead extraction (2000: n= 255; 2011: n = 215). There was an increase in the rates of MAE and death associated with lead extraction increased between 2000 and 2011 (MAE p = 0.0005; death p = 0.037; Figure). By multivariate analysis, the MAE rate increased at high volume centers compared to low volume centers (p = 0.02).
Conclusions: Despite the increasing number of lead extractions performed and a decreasing number of hospitals performing lead extraction, there was an increasing rate of associated adverse events and mortality.
- © 2013 by American Heart Association, Inc.