Epidemiology of cardiac implantable electronic device infections in the United States: A population-based cohort study

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.