title: 16-year trends in the infection burden for pacemakers and implantable cardioverter-defibrillators in the United States 1993 to 2008.
abstract: OBJECTIVE
  We analyzed the infection burden associated with the implantation of cardiac implantable electrophysiological devices (CIEDs) in the United States for the years 1993 to 2008.
  
  
  BACKGROUND
  Recent data suggest that the rate of infection following CIED implantation may be increasing.
  
  
  METHODS
  The Nationwide Inpatient Sample (NIS) discharge records were queried between 1993 and 2008 using the 9th Revision of the International Classification of Diseases (ICD-9-CM). CIED infection was defined as either: 1) ICD-9 code for device-related infection (996.61) and any CIED procedure or removal code; or 2) CIED procedure code along with systemic infection. Patient health profile was evaluated by coding for renal failure, heart failure, respiratory failure, and diabetes mellitus. The infection burden and patient health profile were calculated for each year, and linear regression was used to test for changes over time.
  
  
  RESULTS
  During the study period (1993 to 2008), the incidence of CIED infection was 1.61%. The annual rate of infections remained constant until 2004, when a marked increase was observed, which coincided with an increase in the incidence of major comorbidities. This was associated with a marked increase in mortality and in-hospital financial charges.
  
  
  CONCLUSIONS
  The infection burden associated with CIED implantation is increasing over time and is associated with prolonged hospital stays and high financial costs.
authors.affiliation: Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA 19107, USA. arnold.greenspon@jefferson.edu
authors.forename: Arnold J
authors.initials: AJ
authors.lastname: Greenspon
authors.forename: Jasmine D
authors.initials: JD
authors.lastname: Patel
authors.forename: Edmund
authors.initials: E
authors.lastname: Lau
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Ochoa
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Frisch
authors.forename: Reginald T
authors.initials: RT
authors.lastname: Ho
authors.forename: Behzad B
authors.initials: BB
authors.lastname: Pavri
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kurtz
mesh_terms: D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D006801:Humans; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000191:economics / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology