title: Major complications and mortality within 30 days of an electrophysiological procedure at an academic medical center: implications for developing national standards.
abstract: BACKGROUND
  Despite growing attention to performance and quality measures, national standards for reporting of outcomes after all electrophysiology (EP) procedures have not yet been developed. We sought to characterize the incidence and timing of adverse events up to 30 days after EP procedures at a tertiary academic medical center.
  
  
  RESULTS
  We prospectively followed all patients undergoing EP procedures between January 2010 and September 2012. All were followed for 30 days postprocedure either in clinic or by telephone. Major complications were defined as events related to the procedure that led to prolongation of hospital stay or readmission, required additional procedural intervention, or resulted in death or significant injury. These were further categorized as intraprocedure, postprocedure, or postdischarge events. Seven EP physicians collectively adjudicated whether complications were directly related to the procedure. A total of 3,213 procedures were performed. Major complications occurred in 2.2% of patients; 49% of these events occurred after discharge. Death occurred in 0.6% of patients; 73% of these deaths were found to be secondary to worsening of the patient's underlying comorbid conditions and unrelated to the procedure.
  
  
  CONCLUSIONS
  When considering national standards for reporting outcomes of all EP procedures, continued follow-up after discharge is important. In our cohort, half of major complications occurring within 30 days occurred after discharge. In addition, three-quarters of deaths within 30 days were not directly related to the procedure and caution should be used in using all-cause mortality as an outcome measure for EP procedures.
authors: Penn State Hershey Heart and Vascular Institute, Section of Electrophysiology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA.
authors: Sarah K
authors: SK
authors: Hussain
authors: Division of Cardiology, Section of Electrophysiology, The University of Virginia, Charlottesville, Virginia, USA.
authors: Meghan M
authors: MM
authors: Eddy
authors: Division of Cardiology, Section of Electrophysiology, The University of Virginia, Charlottesville, Virginia, USA.
authors: Liza
authors: L
authors: Moorman
authors: Division of Cardiology, Section of Electrophysiology, The University of Virginia, Charlottesville, Virginia, USA.
authors: Rohit
authors: R
authors: Malhotra
authors: Division of Cardiology, Section of Electrophysiology, The University of Virginia, Charlottesville, Virginia, USA.
authors: Andrew E
authors: AE
authors: Darby
authors: Division of Cardiology, Section of Electrophysiology, The University of Virginia, Charlottesville, Virginia, USA.
authors: Kenneth
authors: K
authors: Bilchick
authors: Division of Cardiology, Section of Electrophysiology, The University of Virginia, Charlottesville, Virginia, USA.
authors: Pamela
authors: P
authors: Mason
authors: Division of Cardiology, Section of Electrophysiology, The University of Virginia, Charlottesville, Virginia, USA.
authors: Michael J
authors: MJ
authors: Mangrum
authors: Division of Cardiology, Section of Electrophysiology, The University of Virginia, Charlottesville, Virginia, USA.
authors: John P
authors: JP
authors: Dimarco
authors: Division of Cardiology, Section of Electrophysiology, The University of Virginia, Charlottesville, Virginia, USA.
authors: John D
authors: JD
authors: Ferguson
mesh_terms: D000046:Academic Medical Centers; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality* / Q000592:standards; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality* / Q000592:standards; D002423:Cause of Death; D015897:Comorbidity; D022062:Electrophysiologic Techniques, Cardiac / Q000009:adverse effects / Q000401:mortality* / Q000592:standards; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D010359:Patient Readmission; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014768:Virginia
keywords: morbidity/mortality; outcomes research; quality improvement