Abstract 16362: Predictors of Adverse Events in 24,890 Patients Undergoing Lead Extraction
Background: Lead extraction has become more common with the increase in pacemaker and defibrillator implantation. Despite the increasing availability of lead extraction the predictors of associated adverse events has only been reported in relatively small patient cohorts. We sought to assess the predictors of mortality and major adverse events in a large cohort of patients based on an administrative dataset.
Methods: De-identified hospital records were obtained from the California Office of Statewide Health Planning and Development for the years 2000-2011. Admissions including the ICD-9 CM procedure codes 37.75, 37.76 or 37.77 (lead extraction) were analyzed. Data dictionaries and ICD-9 codes were used to quantify demographics, comorbidities, and outcomes. Major adverse events (MAE) included death, cardiac tamponade, hemothorax and emergent cardiac surgery. The predictors of in-hospital MAE in patients undergoing lead extraction was estimated using univariate and multivariate binomial mixed effects model with random effects terms for hospital, state and fixed effect terms for demographic and comorbid conditions.
Results: In total, 24,890 hospital discharges specified the procedure of lead extraction. The average age at admission was 43.2 +/- 0.14 years old with 53.7% patients greater than 70 years of age, 40.9% of patients were male, and 53.3% were white. There were 1413 MAE’s (5.7%) that included 426 deaths (1.7%). Pacemaker leads accounted for 56.5% of leads and infection was noted as the indication for extraction in 18.7% of procedures. In multivariate analysis, the predictors of MAE included age < 18 yo (OR 3.25, p < 0.009), heart failure (OR 1.72, p < 0.0001), atrial fibrillation (OR 1.64, p < 0.0001) and lead infection (OR 1.69, p < 0.0001). Predictors of death included lead infection (OR 4.04, p < 0.0001), diabetes (OR 1.62, p = 0.003), heart failure (OR 2.82, p < 0.0001) and atrial fibrillation (OR 1.85, p < 0.0001).
Conclusions: Heart failure, atrial fibrillation and lead infection represent risk factors for major adverse events and death in patients undergoing lead extraction. Given the increasing medical necessity for lead extraction, determining risk factors for associated procedural complications will become increasingly important.
- © 2013 by American Heart Association, Inc.