Sridhar Arun Raghav Mahankali, Yarlagadda Vivek, Kanmanthareddy Arun, Parasa Sravanthi, Maybrook Ryan, Dawn Buddhadeb, Reddy Yeruva Madhu, Lakkireddy Dhanunjaya
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
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.
Indian Pacing Electrophysiol J. 2016 Sep-Oct;16(5):159-164. doi: 10.1016/j.ipej.2016.10.005. Epub 2016 Oct 21.
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.
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.
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).
Hematoma occurs infrequently after ICD implantation, however, it adversely impacts the cost of procedure and length of stay.
囊袋血肿是心脏设备植入后最常见的并发症之一。本研究探讨了该并发症对植入式心律转复除颤器（ICD）植入后院内结局的影响。
查询2010年全国住院患者样本（NIS）的数据，使用ICD-9编码识别2010年期间所有ICD和心脏再同步治疗除颤器（CRT-D）的初次植入情况。然后我们确定了在住院期间发生与手术相关血肿的患者。我们比较了有和没有血肿并发症患者的结局。所有分析均使用SPSS 20复杂样本，并使用适当权重来调整国家数据库的复杂抽样设计。
在2010年总共85276例ICD初次植入中，2233例（占植入病例的2.6%）发生了血肿并发症。年龄增加（p<0.001）以及合并症如充血性心力衰竭（比值比（OR）-1.86，p<0.001）、凝血病（OR-2.3，p<0.001）和肾衰竭（OR-1.52，p<0.001）与囊袋血肿形成风险增加相关。与没有血肿的患者相比，发生血肿的患者住院时间更长（9.1天对5.5天，p<0.001）且住院费用更高（56545美元对47015美元，p<0.001）。与ICD植入相关的总体死亡率较低（0.6%），血肿形成对死亡率没有不利影响（0.6%对0.4%，p=0.63）。
ICD植入后血肿发生率较低，然而，它对手术费用和住院时间有不利影响。
