Mortality and 30-Day Readmission Rates After Inpatient Leadless Pacemaker Implantation: Insights From a Nationwide Readmissions Database

This study aimed to provide real-world data on the rates, trends, and predictors of in-hospital complications and 30-day readmission following leadless pacemaker (LP) implantation. We analysed leadless and conventional pacemaker implantations with the use of the all-payer, nationally representative Nationwide Readmissions Database from 2017 to 2019. The national trends of in-hospital mortality, in-hospital complications, and 30-day readmission rates after pacemaker implantation were analysed. Mixed-effects multivariable logistic regression analysis was performed to identify factors associated with in-hospital death and 30-day readmission in LP patients. A total of 137,732 admissions (age 78 years, IQR 70-85 years, 5986 LP implantations) were analysed. The in-hospital mortality, overall in-hospital complication, and 30-day readmission rates after LP implantations were 5.0%, 16%, and 16%, respectively. In LP recipients, the national estimate of in-hospital mortality declined from 10.9% in the second quarter of 2017 to 4.3% in the fourth quarter of 2019 (P < 0.001). Furthermore, the national estimate of overall complications declined from 20.6% in the second quarter of 2017 to 13.0% in the fourth quarter of 2019 (P < 0.001). In LP recipients, female sex, history of chronic kidney disease, heart failure, and malnutrition were factors associated with in-hospital death. Analysis of the nationally representative claims database from the United States showed in-hospital mortality and complication rates (for LP implantation performed during hospitalisation) of 5.0% and 16%, respectively. Although these rates showed a decreasing trend over time, ongoing surveillance is needed for the safety of LP implantation. Cette étude visait à produire des données en contexte réel sur le taux de complications hospitalières, les tendances et les facteurs prédictifs de telles complications, ainsi que sur la réadmission dans les 30 jours après l’implantation d’un stimulateur cardiaque sans fil. Nous avons analysé les implantations de stimulateurs cardiaques conventionnels et sans fil à l’aide des données de 2017 à 2019 de la Nationwide Readmissions Database provenant de tous les assureurs et représentatives à l’échelle nationale. Les tendances nationales relatives à la mortalité à l’hôpital, aux complications à l’hôpital et au taux de réadmission dans les 30 jours après l’implantation d’un stimulateur cardiaque ont été analysées. Une analyse par régression logistique multivariée à