title: Patient demographics, complications, and hospital utilization in 250 consecutive device implants in a new community hospital electrophysiology program--implications for 'niche' hospitals.
abstract: BACKGROUND
  Single-center reports on patient demographics and early (<6 weeks) device complication rates in academic hospitals are scant and non-existent for non-academic community hospital electrophysiology (EP) programs.
  
  
  OBJECTIVE
  The objective of our study was to examine the demographics, complications, re-admissions, and accessibility of care in a community EP program to add to the body of knowledge of 'real-world' defibrillator implant complications.
  
  
  METHODS
  Two hundred and fifty consecutive patients who underwent device implantation by a single electrophysiologist in a new non-academic community hospital EP program starting from its inception in July 2008 were included for analysis. Standard procedures for implantation were used. Pacemakers, defibrillators, and generator changes were included; temporary pacemakers were excluded. Major complications were defined as in-hospital death, cardiac arrest, cardiac perforation, cardiac valve injury, coronary venous dissection, hemothorax, pneumothorax, transient ischemic attack, stroke, myocardial infarction, pericardial tamponade, and arteriovenous fistula. Minor complications were defined as drug reaction, conduction block, hematoma or lead dislodgement requiring re-operation, peripheral embolus, phlebitis, peripheral nerve injury, and device-related infection.
  
  
  RESULTS
  This community cohort had similar ejection fractions but was older with worse kidney function than those studied in prior reports. There was one major early complication (0.4%) and seven minor early complications (2.8%). Left ventricular lead placement was successful in 64 of 66 patients (97%).
  
  
  CONCLUSIONS
  This is the first community-hospital-based EP program to examine device implant demographics and outcomes, and revealed an elderly, ill population with lower overall rates of complications than seen in national trials and available reports from single non-community centers. Contrary to current perceptions, these data suggest that community centers may subselect an elderly, ill patient population and can provide high-quality, cost-effective, and more accessible care.
authors.affiliation: Clinical Cardiac Electrophysiology, The Good Samaritan Health System, Lebanon Cardiology Associates, Lebanon, PA 17042, USA. lcaep@hotmail.com
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Williams
authors.forename: David
authors.initials: D
authors.lastname: Lugg
authors.forename: Robert
authors.initials: R
authors.lastname: Gray
authors.forename: Douglas
authors.initials: D
authors.lastname: Hollis
authors.forename: Michelle
authors.initials: M
authors.lastname: Stoner
authors.forename: Robert
authors.initials: R
authors.lastname: Stevenson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000706:statistics & numerical data*; D003710:Demography; D004594:Electrophysiology / Q000379:methods / Q000639:trends*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D016730:Program Development; D015397:Program Evaluation; D011446:Prospective Studies; D013318:Stroke Volume; D016277:Ventricular Function, Left