title: Incidence, predictors and outcomes of hematoma after ICD implantation: An analysis of a nationwide database of 85,276 patients.
abstract: BACKGROUND
  Pocket hematoma is one of the most common complications following cardiac device implantation. This study examined the impact of this complication on in-hospital outcomes following Implantable Cardioverter Defibrillator (ICD) implantation.
  
  
  METHODS
  Data from Nationwide Inpatient Sample (NIS) 2010 was queried to identify all primary implantations of ICDs and Cardiac Resynchronization Therapy Defibrillators (CRT-D) during the year 2010 using ICD-9 codes. We then identified the patients who experienced a procedure related hematoma during the hospital stay. We compared the outcomes of the patients with and without a hematoma complication. All analyses were performed using SPSS 20 complex samples using appropriate weights to adjust for the complex sampling design of the national database.
  
  
  RESULTS
  Out of a total of 85,276 primary ICD implantations in the year 2010, 2233 (2.6% of the implantations) were complicated by a hematoma. Increased age (p < 0.001), and comorbidities such as congestive heart failure (odds ratio (OR) - 1.86, p < 0.001), coagulopathy (OR - 2.3, p < 0.001) and renal failure (OR - 1.52, p < 0.001) were associated with an increased risk of pocket hematoma formation. Patients who developed a hematoma had a longer hospitalization (9.1 days versus 5.5 days, p < 0.001) and higher in-hospital costs ($56,545 versus $47,015, p < 0.001) compared to patients who did not have a hematoma. Overall mortality associated with ICD implantation was low (0.6%), and hematoma formation did not adversely affect mortality (0.6% versus 0.4%, p = 0.63).
  
  
  CONCLUSIONS
  Hematoma occurs infrequently after ICD implantation, however, it adversely impacts the cost of procedure and length of stay.
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Arun Raghav Mahankali
authors.initials: AR
authors.lastname: Sridhar
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, The University of Kansas Hospital & Medical Center, 3901 Rainbow Boulevard MS 4023, Kansas City, KS 66160-7200, USA.
authors.forename: Vivek
authors.initials: V
authors.lastname: Yarlagadda
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, The University of Kansas Hospital & Medical Center, 3901 Rainbow Boulevard MS 4023, Kansas City, KS 66160-7200, USA.
authors.forename: Arun
authors.initials: A
authors.lastname: Kanmanthareddy
authors.affiliation: The University of Kanas Medical Center, 3901 Rainbow Boulevard MS 4023, Kansas City, KS 66160-7200, USA.
authors.forename: Sravanthi
authors.initials: S
authors.lastname: Parasa
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, The University of Kansas Hospital & Medical Center, 3901 Rainbow Boulevard MS 4023, Kansas City, KS 66160-7200, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Maybrook
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, The University of Kansas Hospital & Medical Center, 3901 Rainbow Boulevard MS 4023, Kansas City, KS 66160-7200, USA.
authors.forename: Buddhadeb
authors.initials: B
authors.lastname: Dawn
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, The University of Kansas Hospital & Medical Center, 3901 Rainbow Boulevard MS 4023, Kansas City, KS 66160-7200, USA.
authors.forename: Yeruva Madhu
authors.initials: YM
authors.lastname: Reddy
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, The University of Kansas Hospital & Medical Center, 3901 Rainbow Boulevard MS 4023, Kansas City, KS 66160-7200, USA. Electronic address: dlakkireddy@kumc.edu.
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
keywords: CRT-D; Implantable Cardioverter Defibrillator; Pocket hematoma