title: Infection and readmission rate of cardiac implantable electronic device insertions: An observational single center study.
abstract: BACKGROUND
  Infection is one of the most serious complications following surgical placement of cardiac implantable electronic devices (CIEDs). Infection prevention efforts are necessary in reducing CIED infectious outcomes. These devices, however, are commonly inserted in higher risk patients, which may explain the ongoing risk of surgical site infection (SSI) in this population. The rates of CIED infection and utilization vary widely in the literature. The definitions of infection may also vary between clinical definitions and the National Healthcare Safety Network (NHSN) criteria.
  
  
  METHODS
  The primary objective of this study was to review patient data to identify risk factors for infection and readmission after CIED placement at an academic medical center. The secondary objectives were to compare the rates of SSI identified by NHSN criteria compared to that obtained by applying clinical infection definitions.
  
  
  RESULTS
  The overall rate of infection (SSI) was 1.9%, which was identical in both the clinical definition and NHSN reported data. The 30 day readmission rate and the 90 day readmission rate were 12.7% and 25.6% respectively with the most readmissions related to the patients' underlying medical conditions. A lower ejection fraction (EF) was identified as an independent risk factor for readmission, inpatient procedures, smoking and device infection were also significantly associated with readmission after CIED insertion.
authors.affiliation: Medicine Department, University of Pittsburgh Medical Center Mercy, Pittsburgh, PA.
authors.forename: Riaz
authors.initials: R
authors.lastname: Rahman
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Samir
authors.initials: S
authors.lastname: Saba
authors.affiliation: Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Raveen
authors.initials: R
authors.lastname: Bazaz
authors.affiliation: Division of Hospital Medicine, University of California San Diego, San Diego, CA.
authors.forename: Vineet
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Infection Control, University of Pittsburgh Medical Center Mercy, Pittsburgh, PA.
authors.forename: Marian
authors.initials: M
authors.lastname: Pokrywka
authors.affiliation: Infectious Diseases Biostatistics, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Shutt
authors.affiliation: Infection Control, University of Pittsburgh Medical Center Mercy, Pittsburgh, PA.
authors.forename: Christine
authors.initials: C
authors.lastname: Bridge
authors.affiliation: Medicine Department, University of Pittsburgh Medical Center Mercy, Pittsburgh, PA; Infection Control, University of Pittsburgh Medical Center Mercy, Pittsburgh, PA; Biostatistics, Infectious Diseases Division, University of Pittsburgh, Pittsburgh, PA. Electronic address: mhy8@pitt.edu.
authors.forename: Mohamed H
authors.initials: MH
authors.lastname: Yassin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058409:Cardiac Resynchronization Therapy Devices / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D015995:Prevalence; D016459:Prosthesis-Related Infections / Q000453:epidemiology*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology*
keywords: Cardiac implantable electronic devices; Infection; National Healthcare Safety Network; Readmission rate; Surgical site infection