title: Trends in Use and Adverse Outcomes Associated with Transvenous Lead Removal in the United States.
abstract: BACKGROUND
  Transvenous lead removal (TLR) has made significant progress with respect to innovation, efficacy, and safety. However, limited data exist regarding trends in use and adverse outcomes outside the centers of considerable experience for TLR. The aim of our study was to examine use patterns, frequency of adverse events, and influence of hospital volume on complications.
  
  
  RESULTS
  Using the Nationwide Inpatient Sample, we identified 91 890 TLR procedures. We investigated common complications including pericardial complications (hemopericardium, cardiac tamponade, or pericardiocentesis), pneumothorax, stroke, vascular complications (consisting of hemorrhage/hematoma, incidents requiring surgical repair, and accidental arterial puncture), and in-hospital deaths described with TLR, defining them by the validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code. We specifically assessed in-hospital death (2.2%), hemorrhage requiring transfusion (2.6%), vascular complications (2.0%), pericardial complications (1.4%), open heart surgery (0.2%), and postoperative respiratory failure (2.4%). Independent predictors of complications were female sex and device infections. Hospital volume was not independently associated with higher complications. There was a significant rise in overall complication rates over the study period.
  
  
  CONCLUSIONS
  The overall complication rate in patients undergoing TLR was higher than previously reported. Female sex and device infections are associated with higher complications. Hospital volume was not associated with higher complication rates. The number of adverse events in the literature likely underestimates the actual number of complications associated with TLR.
authors.affiliation: From Mayo Clinic, Rochester, MN (A.D., P.A.N., S.K., A.N., S.M., Y.M.C., P.F., S. Asirvatham); University of Miami Miller School of Medicine, Miami, FL (N.P., J.O.C., J.F.V.-G.); Icahn School of Medicine at Mount Sinai, New York, NY (A.A.P., S. Arora); Yale New Haven Medical Center, New Haven, CT (A.B.); St. Jude Medical, Sylmar, CA (A.F.); and Saint Peter's University Hospital/Rutgers University, New Brunswick, NJ (N.P.). deshmukh.abhishek@mayo.edu.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: From Mayo Clinic, Rochester, MN (A.D., P.A.N., S.K., A.N., S.M., Y.M.C., P.F., S. Asirvatham); University of Miami Miller School of Medicine, Miami, FL (N.P., J.O.C., J.F.V.-G.); Icahn School of Medicine at Mount Sinai, New York, NY (A.A.P., S. Arora); Yale New Haven Medical Center, New Haven, CT (A.B.); St. Jude Medical, Sylmar, CA (A.F.); and Saint Peter's University Hospital/Rutgers University, New Brunswick, NJ (N.P.).
authors.forename: Nileshkumar
authors.initials: N
authors.lastname: Patel
authors.affiliation: From Mayo Clinic, Rochester, MN (A.D., P.A.N., S.K., A.N., S.M., Y.M.C., P.F., S. Asirvatham); University of Miami Miller School of Medicine, Miami, FL (N.P., J.O.C., J.F.V.-G.); Icahn School of Medicine at Mount Sinai, New York, NY (A.A.P., S. Arora); Yale New Haven Medical Center, New Haven, CT (A.B.); St. Jude Medical, Sylmar, CA (A.F.); and Saint Peter's University Hospital/Rutgers University, New Brunswick, NJ (N.P.).
authors.forename: Peter A
authors.initials: PA
authors.lastname: Noseworthy
authors.affiliation: From Mayo Clinic, Rochester, MN (A.D., P.A.N., S.K., A.N., S.M., Y.M.C., P.F., S. Asirvatham); University of Miami Miller School of Medicine, Miami, FL (N.P., J.O.C., J.F.V.-G.); Icahn School of Medicine at Mount Sinai, New York, NY (A.A.P., S. Arora); Yale New Haven Medical Center, New Haven, CT (A.B.); St. Jude Medical, Sylmar, CA (A.F.); and Saint Peter's University Hospital/Rutgers University, New Brunswick, NJ (N.P.).
authors.forename: Achint A
authors.initials: AA
authors.lastname: Patel
authors.affiliation: From Mayo Clinic, Rochester, MN (A.D., P.A.N., S.K., A.N., S.M., Y.M.C., P.F., S. Asirvatham); University of Miami Miller School of Medicine, Miami, FL (N.P., J.O.C., J.F.V.-G.); Icahn School of Medicine at Mount Sinai, New York, NY (A.A.P., S. Arora); Yale New Haven Medical Center, New Haven, CT (A.B.); St. Jude Medical, Sylmar, CA (A.F.); and Saint Peter's University Hospital/Rutgers University, New Brunswick, NJ (N.P.).
authors.forename: Nilay
authors.initials: N
authors.lastname: Patel
authors.affiliation: From Mayo Clinic, Rochester, MN (A.D., P.A.N., S.K., A.N., S.M., Y.M.C., P.F., S. Asirvatham); University of Miami Miller School of Medicine, Miami, FL (N.P., J.O.C., J.F.V.-G.); Icahn School of Medicine at Mount Sinai, New York, NY (A.A.P., S. Arora); Yale New Haven Medical Center, New Haven, CT (A.B.); St. Jude Medical, Sylmar, CA (A.F.); and Saint Peter's University Hospital/Rutgers University, New Brunswick, NJ (N.P.).
authors.forename: Shilpkumar
authors.initials: S
authors.lastname: Arora
authors.affiliation: From Mayo Clinic, Rochester, MN (A.D., P.A.N., S.K., A.N., S.M., Y.M.C., P.F., S. Asirvatham); University of Miami Miller School of Medicine, Miami, FL (N.P., J.O.C., J.F.V.-G.); Icahn School of Medicine at Mount Sinai, New York, NY (A.A.P., S. Arora); Yale New Haven Medical Center, New Haven, CT (A.B.); St. Jude Medical, Sylmar, CA (A.F.); and Saint Peter's University Hospital/Rutgers University, New Brunswick, NJ (N.P.).
authors.forename: Suraj
authors.initials: S
authors.lastname: Kapa
authors.affiliation: From Mayo Clinic, Rochester, MN (A.D., P.A.N., S.K., A.N., S.M., Y.M.C., P.F., S. Asirvatham); University of Miami Miller School of Medicine, Miami, FL (N.P., J.O.C., J.F.V.-G.); Icahn School of Medicine at Mount Sinai, New York, NY (A.A.P., S. Arora); Yale New Haven Medical Center, New Haven, CT (A.B.); St. Jude Medical, Sylmar, CA (A.F.); and Saint Peter's University Hospital/Rutgers University, New Brunswick, NJ (N.P.).
authors.forename: Amit
authors.initials: A
authors.lastname: Noheria
authors.affiliation: From Mayo Clinic, Rochester, MN (A.D., P.A.N., S.K., A.N., S.M., Y.M.C., P.F., S. Asirvatham); University of Miami Miller School of Medicine, Miami, FL (N.P., J.O.C., J.F.V.-G.); Icahn School of Medicine at Mount Sinai, New York, NY (A.A.P., S. Arora); Yale New Haven Medical Center, New Haven, CT (A.B.); St. Jude Medical, Sylmar, CA (A.F.); and Saint Peter's University Hospital/Rutgers University, New Brunswick, NJ (N.P.).
authors.forename: Siva
authors.initials: S
authors.lastname: Mulpuru
authors.affiliation: From Mayo Clinic, Rochester, MN (A.D., P.A.N., S.K., A.N., S.M., Y.M.C., P.F., S. Asirvatham); University of Miami Miller School of Medicine, Miami, FL (N.P., J.O.C., J.F.V.-G.); Icahn School of Medicine at Mount Sinai, New York, NY (A.A.P., S. Arora); Yale New Haven Medical Center, New Haven, CT (A.B.); St. Jude Medical, Sylmar, CA (A.F.); and Saint Peter's University Hospital/Rutgers University, New Brunswick, NJ (N.P.).
authors.forename: Apurva
authors.initials: A
authors.lastname: Badheka
authors.affiliation: From Mayo Clinic, Rochester, MN (A.D., P.A.N., S.K., A.N., S.M., Y.M.C., P.F., S. Asirvatham); University of Miami Miller School of Medicine, Miami, FL (N.P., J.O.C., J.F.V.-G.); Icahn School of Medicine at Mount Sinai, New York, NY (A.A.P., S. Arora); Yale New Haven Medical Center, New Haven, CT (A.B.); St. Jude Medical, Sylmar, CA (A.F.); and Saint Peter's University Hospital/Rutgers University, New Brunswick, NJ (N.P.).
authors.forename: Avi
authors.initials: A
authors.lastname: Fischer
authors.affiliation: From Mayo Clinic, Rochester, MN (A.D., P.A.N., S.K., A.N., S.M., Y.M.C., P.F., S. Asirvatham); University of Miami Miller School of Medicine, Miami, FL (N.P., J.O.C., J.F.V.-G.); Icahn School of Medicine at Mount Sinai, New York, NY (A.A.P., S. Arora); Yale New Haven Medical Center, New Haven, CT (A.B.); St. Jude Medical, Sylmar, CA (A.F.); and Saint Peter's University Hospital/Rutgers University, New Brunswick, NJ (N.P.).
authors.forename: James O
authors.initials: JO
authors.lastname: Coffey
authors.affiliation: From Mayo Clinic, Rochester, MN (A.D., P.A.N., S.K., A.N., S.M., Y.M.C., P.F., S. Asirvatham); University of Miami Miller School of Medicine, Miami, FL (N.P., J.O.C., J.F.V.-G.); Icahn School of Medicine at Mount Sinai, New York, NY (A.A.P., S. Arora); Yale New Haven Medical Center, New Haven, CT (A.B.); St. Jude Medical, Sylmar, CA (A.F.); and Saint Peter's University Hospital/Rutgers University, New Brunswick, NJ (N.P.).
authors.forename: Yong Mei
authors.initials: YM
authors.lastname: Cha
authors.affiliation: From Mayo Clinic, Rochester, MN (A.D., P.A.N., S.K., A.N., S.M., Y.M.C., P.F., S. Asirvatham); University of Miami Miller School of Medicine, Miami, FL (N.P., J.O.C., J.F.V.-G.); Icahn School of Medicine at Mount Sinai, New York, NY (A.A.P., S. Arora); Yale New Haven Medical Center, New Haven, CT (A.B.); St. Jude Medical, Sylmar, CA (A.F.); and Saint Peter's University Hospital/Rutgers University, New Brunswick, NJ (N.P.).
authors.forename: Paul
authors.initials: P
authors.lastname: Friedman
authors.affiliation: From Mayo Clinic, Rochester, MN (A.D., P.A.N., S.K., A.N., S.M., Y.M.C., P.F., S. Asirvatham); University of Miami Miller School of Medicine, Miami, FL (N.P., J.O.C., J.F.V.-G.); Icahn School of Medicine at Mount Sinai, New York, NY (A.A.P., S. Arora); Yale New Haven Medical Center, New Haven, CT (A.B.); St. Jude Medical, Sylmar, CA (A.F.); and Saint Peter's University Hospital/Rutgers University, New Brunswick, NJ (N.P.).
authors.forename: Samuel
authors.initials: S
authors.lastname: Asirvatham
authors.affiliation: From Mayo Clinic, Rochester, MN (A.D., P.A.N., S.K., A.N., S.M., Y.M.C., P.F., S. Asirvatham); University of Miami Miller School of Medicine, Miami, FL (N.P., J.O.C., J.F.V.-G.); Icahn School of Medicine at Mount Sinai, New York, NY (A.A.P., S. Arora); Yale New Haven Medical Center, New Haven, CT (A.B.); St. Jude Medical, Sylmar, CA (A.F.); and Saint Peter's University Hospital/Rutgers University, New Brunswick, NJ (N.P.).
authors.forename: Juan F
authors.initials: JF
authors.lastname: Viles-Gonzalez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual / Q000639:trends*; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000639:trends*; D020878:Device Removal / Q000009:adverse effects / Q000639:trends*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology*; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: complications; device infection; lead removal