title: Cardiac Implantable Electronic Device-Related Infection and Extraction Trends in the U.S.
abstract: BACKGROUND
  Implantation of cardiac implanted electronic device (CIED) has surged lately. This resulted in a rise in cardiac device-related infections (CDI) and inevitably, lead extractions. We examined the recent national trend in the incidence of CIED infections and lead extractions in hospitalized patients and associated mortality.
  
  
  METHODS
  Using the Nationwide Inpatient Sample for the years 2003-2011 we identified patients diagnosed with a CDI-associated infection as determined by discharge ICD-9 diagnostic codes. We examined the trend of device-related infections overall and in different subgroups. We studied mortality associated with device infections, lead extractions, associated costs, and length of stay.
  
  
  RESULTS
  There is a significant increase in the number of hospitalizations due to CDI from 5,308 in the year 2003 to 9,948 in 2011. Males (68%), Caucasians (77%), and age group 65-84 years (56.4%) accounted for majority of CDI. The mortality associated with CDI was 4.5 %, and was worse in higher age groups (2.5% in 18-44 years compared to 5.3% in 85+ years, P < 0.001). Average length of stay was unchanged over the years remaining at 13.6 days; however, mean hospitalization charges increased from $91,348 in 2003 to $173,211 in 2011 (P < 0.001). Among all lead extraction procedures, the percentage of patients undergoing lead extraction secondary to CDI also increased from 2003 (59.1%) to 2011 (76.7%), P-value < 0.001.
  
  
  CONCLUSIONS
  Healthcare burden associated with CDI infections and associated lead extractions has significantly increased in the recent years. Despite an increase in cost associated with CIED infections, mortality remains the same, and is higher in older patients.
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Arun Raghav Mahankali
authors.initials: AR
authors.lastname: Sridhar
authors.affiliation: Divison of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas.
authors.forename: Madhav
authors.initials: M
authors.lastname: Lavu
authors.affiliation: Department of Internal Medicine, Atlanticare Medical Center, Atlantic City, New Jersey.
authors.forename: Vivek
authors.initials: V
authors.lastname: Yarlagadda
authors.affiliation: Divison of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas.
authors.forename: Madhu
authors.initials: M
authors.lastname: Reddy
authors.affiliation: Divison of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas.
authors.forename: Sampath
authors.initials: S
authors.lastname: Gunda
authors.affiliation: Divison of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Afzal
authors.affiliation: Divison of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas.
authors.forename: Donita
authors.initials: D
authors.lastname: Atkins
authors.affiliation: Department of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Gopinathanair
authors.affiliation: Divison of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas.
authors.forename: Buddhadeb
authors.initials: B
authors.lastname: Dawn
authors.affiliation: Divison of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas.
authors.forename: Dhanunjaya R
authors.initials: DR
authors.lastname: Lakkireddy
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D017147:Defibrillators, Implantable / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D020878:Device Removal / Q000191:economics* / Q000401:mortality* / Q000639:trends; D005260:Female; D005544:Forecasting; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D016459:Prosthesis-Related Infections / Q000191:economics* / Q000401:mortality* / Q000517:prevention & control; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: cardiac pacemaker; implantable cardioverter defibrillator; lead extraction; lead infection