The frequency and incremental cost of major complications among medicare beneficiaries receiving implantable cardioverter-defibrillators.
OBJECTIVE
We aimed to quantify the frequency and nature of early complications after implantable cardioverter-defibrillator (ICD) implantation in general practice, and estimate the incremental costs of those complications to the health care system.


BACKGROUND
Cardioverter-defibrillator implantation rates are rising quickly. Little has been published regarding the outcomes and costs of these procedures in unselected populations.


METHODS
Using Medicare Provider Analysis and Review (MedPAR) files, we identified 30,984 admissions containing procedure codes for new ICD or cardiac resynchronization therapy defibrillator implantation in fiscal year 2003. The frequencies of eight complicating diagnoses during these admissions were determined. Length of stay (LOS) and total hospital costs, derived using whole-hospital cost to charge ratios, were calculated for each admission. The incremental effects of any and each complication on LOS and hospital cost were estimated in multivariable models, adjusting for demographic factors and comorbid conditions.


RESULTS
The mean cost for all admissions was 42,184 dollars (median 37,902 dollars) with mean LOS of 4.7 days (median 2.0 days). One or more complications were coded in 10.8% of admissions, most commonly "mechanical complication of the ICD" and hemorrhage/hematoma. The occurrence of any complication increased adjusted LOS by 3.4 days and costs by 7,251 dollars. Each of the individual complications was associated with highly significant increases in both LOS (1 to 10 days) and hospital cost (5,000 dollars to 20,000 dollars).


CONCLUSIONS
In fiscal 2003, 10.8% of Medicare patients undergoing cardioverter-defibrillator implantation experienced one or more early complications, associated with significant increases in LOS and costs. Efforts to reduce these complications could have significant clinical and financial benefits.
Reynolds
Matthew R
MR
Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. mreynold@bidmc.harvard.edu
Cohen
David J
DJ
Kugelmass
Aaron D
AD
Brown
Phillip P
PP
Becker
Edmund R
ER
Culler
Steven D
SD
Simon
April W
AW
D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology / Q000209:etiology; D014481:United States