title: Safety of pacemaker implantation in nonagenarians: an analysis of the healthcare cost and utilization project-nationwide inpatient sample.
abstract: BACKGROUND
  Data are scarce on outcomes of pacemaker implantation in nonagenarians (age≥90 years).
  
  
  RESULTS
  We identified patients >70 years of age (n=115 683) who underwent initial pacemaker implantation in the 2004 to 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 χ(2) 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 years of age. Relative to patients aged 70 to 79 years, patients >90 years of age were more likely to have moderate/severe comorbidity (Charlson score >1; 43.2% versus 40.1%) and less likely to be admitted electively (17.5% versus 29.9%), all P<0.001. The unadjusted mortality and complication rates in patients aged 70 to 79 years were 0.60% (confidence interval [CI], 0.53-0.67%) and 5.61% (CI, 5.40-5.82%), respectively, and in patients aged >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 aged 70 to 79 years were 3.22 days (CI, 3.20-3.24 days) and $38 871 (CI, $38 700-$39 043), and in patients aged >90 years, 4.27 days (CI, 4.25-4.30 days) and $41 373 (CI, $41 190-$41 556). Multivariable analysis revealed severe comorbidity (odds ratio, 5.00; 95% CI, 4.05-6.17) was a greater predictor of mortality than increasing age (odds ratio, 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.
authors.affiliation: Section of Cardiovascular Medicine, Yale University School of Medicine, 789 Howard Avenue, Dana 319, New Haven, CT 06520, USA.
authors.forename: Anant
authors.initials: A
authors.lastname: Mandawat
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
authors.forename: Aditya
authors.initials: A
authors.lastname: Mandawat
authors.forename: Valentine Y
authors.initials: VY
authors.lastname: Njike
authors.forename: Rachel
authors.initials: R
authors.lastname: Lampert
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000191:economics / Q000401:mortality* / Q000628:therapy*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D010138:Pacemaker, Artificial / Q000009:adverse effects* / Q000191:economics / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D014481:United States / Q000453:epidemiology