Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada; Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada.
Duke Clinical Research Institute, Duke University, Durham, North Carolina.
Heart Rhythm. 2020 Jul;17(7):1125-1131. doi: 10.1016/j.hrthm.2020.02.012. Epub 2020 Feb 20.
Trends in cardiac implantable electronic device (CIED) infections have been studied previously. However, coding for administrative data is more granular in contemporary data sets and indications for CIED implantation have expanded.
The purpose of this study was to provide an update on the rates of CIED infection and the influence of different variables including sex, length of stay (LOS), and costs in the United States.
Data from the 2016 Healthcare Care and Utilization Project National Inpatient Sample database were utilized. International Classification of Diseases, Tenth Revision codes were used to track CIED infections. Demographic and clinical characteristics were collected including Elixhauser comorbidities. The univariate and multivariate logistic and linear regression models were used to assess mortality, costs, and LOS.
Of 191,610 CIED implantations identified in the Healthcare Cost and Utilization Project National Inpatient Sample database in 2016, 8060 infections (4.2%) were identified. The in-hospital mortality rate for these patients was 4.7%. The majority of patients (68.9%) with CIED infection had ≥3 Elixhauser comorbidities. Women had decreased LOS and costs compared with men, and patients with ≥3 comorbidities had increased costs and LOS.
We identified that the majority of patients with CIED infection had ≥3 comorbidities that were associated with increased costs and LOS. The observed sex differences in health care resource utilization and in-hospital costs among patients admitted with CIED infection requires further exploration. Patients with increased numbers of comorbidities should be recognized and managed carefully peri-CIED implantation given their increased risk of infection and use of health care resources.
先前已经研究过心脏植入式电子设备 (CIED) 感染的趋势。然而，在当代数据集中，行政数据的编码更为精细，CIED 植入的适应证也有所扩大。
本研究旨在提供美国 CIED 感染率的最新数据，并探讨不同变量（包括性别、住院时间 (LOS) 和费用）的影响。
本研究使用了 2016 年医疗保健利用项目国家住院样本数据库的数据。采用国际疾病分类第 10 次修订版 (ICD-10) 代码来追踪 CIED 感染。收集了人口统计学和临床特征，包括 Elixhauser 合并症。采用单变量和多变量逻辑回归和线性回归模型评估死亡率、费用和 LOS。
在 2016 年医疗保健费用和利用项目国家住院样本数据库中，共确定了 191610 例 CIED 植入病例，其中 8060 例（4.2%）发生了感染。这些患者的院内死亡率为 4.7%。大多数（68.9%）CIED 感染患者有 ≥3 种 Elixhauser 合并症。与男性相比，女性的 LOS 和费用较低，患有 ≥3 种合并症的患者费用和 LOS 增加。
我们发现，大多数 CIED 感染患者有 ≥3 种合并症，这些合并症与费用增加和 LOS 延长有关。CIED 感染住院患者的性别差异在卫生保健资源利用和住院费用方面值得进一步探讨。鉴于感染风险和卫生保健资源使用增加，应注意识别和管理患有更多合并症的患者。
