Basil Hetzel Institute for Translational Research, University of Adelaide, and Central Adelaide Local Health Network, Adelaide, South Australia, Australia (I.R.).
University of Adelaide, Adelaide, South Australia, Australia (C.L., T.A.).
Ann Intern Med. 2019 Sep 3;171(5):309-317. doi: 10.7326/M18-2810. Epub 2019 Jul 30.
Cardiovascular implantable electronic devices (CIEDs) are associated with procedure-related complications, yet little is known about variation in complication rates among institutions that may suggest disparities in care quality.
To assess institutional variation in risk-standardized complication rates (RSCRs) for CIED.
Cohort study.
174 hospitals in Australia and New Zealand, 98 of which implanted at least 25 CIEDs during the study period.
81 304 patients older than 18 years (mean, 74.7 years [SD, 12.4]; 37.9% female) who received a new CIED (65 711 permanent pacemakers [PPMs] and 15 593 implantable cardioverter-defibrillators [ICDs]) in 2010 to 2015.
RSCRs and frequencies of major device-related complications during hospitalization or within 90 days of discharge.
Of the cohort, 6664 patients (8.2%) had a major complication. Although complication rates were higher for ICDs than PPMs (10.04% vs. 7.76%), 76.5% of all complications were attributable to PPMs (5098 vs. 1566 for ICDs). Among hospitals that implanted at least 25 CIEDs, the median RSCR was 8.1%; however, rates varied from 5.3% to 14.3%, with 22 hospitals identified as having RSCRs that differed significantly from the national average. Similar variation was observed when RSCRs for PPM implantation (n = 96 hospitals) (median RSCR, 7.6% [range, 5.4% to 12.9%]) were considered separately from those for ICD placement (n = 68 hospitals) (median RSCR, 9.7% [range, 6.2% to 16.9%]) and persisted when only elective procedures were assessed (n = 88 hospitals) (median RSCR, 7.4% [range, 4.7% to 13.0%]).
Possible unmeasured confounding from the use of administrative data.
CIED complications are common and vary among hospitals, suggesting institutional variation in CIED care quality. Concerted clinical and policy interventions are needed to address CIED-related complications. These efforts should preferentially target PPMs, because most CIED complications are attributable to these devices.
The Hospitals Contribution Fund Research Foundation.
心血管植入式电子设备（CIED）与与手术相关的并发症相关，但对于机构之间并发症发生率的差异知之甚少，而这种差异可能表明医疗质量存在差异。
评估 CIED 风险标准化并发症发生率（RSCR）的机构间差异。
队列研究。
澳大利亚和新西兰的 174 家医院，其中 98 家在研究期间至少植入了 25 个 CIED。
81304 名年龄大于 18 岁的患者（平均年龄 74.7 岁[标准差 12.4]；37.9%为女性），他们在 2010 年至 2015 年期间接受了新的 CIED（65711 个永久起搏器[PPM]和 15593 个植入式心律转复除颤器[ICD]）。
住院期间或出院后 90 天内的 RSCR 和主要设备相关并发症的频率。
在队列中，6664 名患者（8.2%）出现了主要并发症。尽管 ICD 的并发症发生率高于 PPM（10.04%比 7.76%），但所有并发症的 76.5%归因于 PPM（5098 例比 ICD 的 1566 例）。在植入至少 25 个 CIED 的医院中，中位 RSCR 为 8.1%；然而，比率从 5.3%到 14.3%不等，有 22 家医院的 RSCR 明显与全国平均水平不同。当分别考虑 PPM 植入的 RSCR（n=96 家医院）（中位 RSCR，7.6%[范围，5.4%至 12.9%]）和 ICD 放置的 RSCR（n=68 家医院）（中位 RSCR，9.7%[范围，6.2%至 16.9%]）时，观察到类似的变化，当仅评估选择性手术时（n=88 家医院）（中位 RSCR，7.4%[范围，4.7%至 13.0%]）也观察到了这种变化。
行政数据使用可能存在未测量的混杂因素。
CIED 并发症很常见，并且在医院之间存在差异，这表明 CIED 护理质量存在机构间差异。需要采取协调一致的临床和政策干预措施来解决与 CIED 相关的并发症。这些努力应优先针对 PPM，因为大多数 CIED 并发症归因于这些设备。
医院贡献基金研究基金会。
