title: Predictors, Morbidity, and Costs Associated with Pneumothorax during Electronic Cardiac Device Implantation.
abstract: BACKGROUND
  Pneumothorax (PTX) is a major cause of morbidity associated with cardiac implantable electronic devices (CIEDs). We sought to evaluate predictors of PTX at our centers during CIED implantations, including the venous access technique utilized, as well as to determine morbidity and costs associated with PTX.
  
  
  METHODS
  We reviewed records of all patients undergoing cardiac device implant or revision with new venous access at our institutions between 2008 and 2014. Common demographic and procedure characteristics were collected including age, sex, body mass index (BMI), comorbidities, and method of venous access (axillary vein vs classic proximal subclavian vein technique).
  
  
  RESULTS
  We identified 1,264 patients who met criteria for our analysis, with a total of 21 PTX cases during CIED implantation. The strongest predictor for PTX was the venous access strategy: 0 of 385 (0%) patients with axillary vein approach versus 21 of 879 (2.4%) with traditional subclavian vein approach, P = 0.0006. Additional predictors of PTX included advanced age, female sex, low BMI, and a new device implant (vs device upgrade). The occurrence of PTX was associated with increased length of stay: 3.0 days (median; interquartile range [IQR] 3) versus 1.0 day (median; IQR: 1), P = 0.0001, with a cost increase of 361.4%.
  
  
  CONCLUSIONS
  An axillary vein vascular access strategy was associated with greatly reduced risk of iatrogenic PTX versus the traditional subclavian approach for CIED placement. Similarly, device upgrade with patent vascular access carried less risk of PTX compared to new device implantation. PTX occurrence significantly prolonged hospitalization and increased costs.
authors.affiliation: Gill Heart Institute, University of Kentucky, Lexington, Kentucky.|VAMC Division of Cardiology, Lexington, Kentucky.
authors.forename: John
authors.initials: J
authors.lastname: Kotter
authors.affiliation: Gill Heart Institute, University of Kentucky, Lexington, Kentucky.
authors.forename: Georges
authors.initials: G
authors.lastname: Lolay
authors.affiliation: Gill Heart Institute, University of Kentucky, Lexington, Kentucky.
authors.forename: Richard
authors.initials: R
authors.lastname: Charnigo
authors.affiliation: Gill Heart Institute, University of Kentucky, Lexington, Kentucky.|VAMC Division of Cardiology, Lexington, Kentucky.
authors.forename: Steve
authors.initials: S
authors.lastname: Leung
authors.affiliation: Gill Heart Institute, University of Kentucky, Lexington, Kentucky.
authors.forename: Christopher
authors.initials: C
authors.lastname: McKibbin
authors.affiliation: Gill Heart Institute, University of Kentucky, Lexington, Kentucky.
authors.forename: Matthew
authors.initials: M
authors.lastname: Sousa
authors.affiliation: Gill Heart Institute, University of Kentucky, Lexington, Kentucky.
authors.forename: Luis
authors.initials: L
authors.lastname: Jimenez
authors.affiliation: Gill Heart Institute, University of Kentucky, Lexington, Kentucky.
authors.forename: John
authors.initials: J
authors.lastname: Gurley
authors.affiliation: Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
authors.forename: Luigi DI
authors.initials: LD
authors.lastname: Biase
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.affiliation: Gill Heart Institute, University of Kentucky, Lexington, Kentucky.|VAMC Division of Cardiology, Lexington, Kentucky.
authors.forename: Susan
authors.initials: S
authors.lastname: Smyth
authors.affiliation: Gill Heart Institute, University of Kentucky, Lexington, Kentucky.
authors.forename: Yousef
authors.initials: Y
authors.lastname: Darrat
authors.affiliation: Gill Heart Institute, University of Kentucky, Lexington, Kentucky.|VAMC Division of Cardiology, Lexington, Kentucky.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Morales
authors.affiliation: Gill Heart Institute, University of Kentucky, Lexington, Kentucky. samy-claude.elayi@uky.edu.|VAMC Division of Cardiology, Lexington, Kentucky. samy-claude.elayi@uky.edu.
authors.forename: Claude S
authors.initials: CS
authors.lastname: Elayi
mesh_terms: D015984:Causality; D017147:Defibrillators, Implantable / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000191:economics* / Q000706:statistics & numerical data; D011030:Pneumothorax / Q000191:economics* / Q000453:epidemiology*; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D019919:Prosthesis Implantation / Q000191:economics* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome