title: Mortality and cost associated with cardiovascular implantable electronic device infections.
abstract: BACKGROUND
  Cardiovascular implantable electronic device (CIED) therapy can reduce morbidity and mortality, but this benefit can be diminished by CIED infection. Currently, there are limited published data on the mortality and cost associated with CIED infection.
  
  
  METHODS
  We analyzed the risk-adjusted total and incremental admission mortality, long-term mortality, admission length of stay (LOS), and admission cost associated with infection in a retrospective cohort of 200 219 Medicare fee-for-service patients admitted for CIED generator implantation, replacement, or revision between January 1, 2007, and December 31, 2007.
  
  
  RESULTS
  There were a total of 5817 admissions with infection. Infection was associated with significant increases in adjusted admission mortality (rate ratios, 4.8-7.7; standardized rates, 4.6%-11.3%) and long-term mortality (rate ratios, 1.6-2.1; standardized rates, 26.5%-35.1%), depending on CIED type. Importantly, approximately half of the incremental long-term mortality occurred after discharge. The adjusted LOS was significantly longer with infection (length of stay mean ratios, 2.5-4.0; standardized length of stay, 15.5-24.3 days), depending on CIED type. The standardized adjusted incremental and total admission costs with infection were $14 360 to $16 498 and $28 676 to $53 349, respectively, depending on CIED type. The largest incremental cost with infection was intensive care, which accounted for more than 40% of the difference. Adjusted long-term mortality rate and cost ratios with infection were significantly greater for pacemakers than for implantable cardioverter/defibrillators or cardiac resynchronization therapy/defibrillator devices.
  
  
  CONCLUSIONS
  Infection associated with CIED procedures resulted in substantial incremental admission mortality and long-term mortality that varied with the CIED type and occurred, in part, after discharge. Almost half of the incremental admission cost was for intensive care.
authors.affiliation: Division of Infectious Diseases, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA. sohail.muhammad@mayo.edu
authors.forename: Muhammad R
authors.initials: MR
authors.lastname: Sohail
authors.forename: Charles A
authors.initials: CA
authors.lastname: Henrikson
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Braid-Forbes
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Forbes
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Lerner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058409:Cardiac Resynchronization Therapy Devices / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000601:surgery*; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D003365:Costs and Cost Analysis; D003422:Critical Care / Q000191:economics*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics; D016459:Prosthesis-Related Infections / Q000191:economics / Q000453:epidemiology / Q000209:etiology; D012086:Reoperation / Q000191:economics; D018570:Risk Assessment; D015996:Survival Rate; D014481:United States