Safety of Pacemaker Implantation in Nonagenarians: An Analysis of the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample
Background—Data are scarce on outcomes of pacemaker (PM) implantation in nonagenarians (age≥90).
Methods and Results—We identified patients ≥ 70 years (N=115,683) who underwent initial PM in the 2004-2008 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. Outcomes included in-hospital mortality, complications, length of stay and charges. Unadjusted outcomes were compared using χ² and Mantel-Haenszel tests. Multivariate hierarchical logistic models and stepwise linear regression models adjusted for case-mix variation and clustering. Eleven percent (12,917) were ≥ 90. Relative to patients 70-79 years, patients ≥ 90 were more likely to have moderate/severe comorbidity (Charlson score >1; 43.2% vs 40.1%) and less likely to be admitted electively (17.5% vs 29.9%), all p<0.001. The unadjusted mortality and complication rates in patients 70-79 years were 0.60% (CI 0.53-0.67%) and 5.61% (CI 5.40-5.82%), respectively, and in patients ≥ 90 years were 1.87% (CI 1.63-2.11%) and 6.31% (CI 5.89-6.72%). Length of stay and charges in patients 70-79 years were 3.22 days (CI 3.20-3.24 days) and $38,871 (CI $38,700-$39,043), and in patients ≥ 90 years, 4.27 days (CI 4.25-4.30 days) and $41,373 (CI $41,190-$41,556). Multivariable analysis revealed severe comorbidity (OR 5.00; 95% CI, 4.05-6.17) was a greater predictor of mortality than increasing age (OR 2.81 per decade; CI 2.35-3.35), all p<0.001. Similarly, severe comorbidity (Charlson score ≥ 5) was more strongly associated with complications, length of stay, and charges than age.
Conclusions—Although increasing age predicts worsening outcomes in the elderly, the absolute rates are modest, even in nonagenarians, and comorbidity is a stronger predictor.
- Received January 23, 2013.
- Revision received February 25, 2013.
- Accepted February 27, 2013.