Heart rhythm · 2026
Cardiovascular implantable electronic device infections requiring extraction: A national analysis of contemporary trends, clinical predictors, and economic burden, 2016-2022.
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Quelal Analuisa Karol, Bittar-Carlini Gianfranco, Elbenawi Hossam R, Tan Nicholas Y, Del-Carpio Munoz Freddy, Deshmukh Abhishek J, Mulpuru Siva K, Cha Yong-Mei, Friedman Paul A, Asirvatham Samuel, Chesdachai Supavit, DeSimone Daniel C, Baddour Larry M, DeSimone Christopher V
Аннотация
BACKGROUND: Cardiovascular implantable electronic device (CIED) infections are characterized by substantial morbidity, mortality, and economic burden. Contemporary national data analysis stratifying CIED infections by reimplantation strategy is limited.
OBJECTIVE: To characterize incidence, patient and hospital predictors, microbiology, in-hospital mortality, and costs of CIED infections requiring device removal stratified by same-admission reimplantation vs those without same-admission reimplantation.
METHODS: Using the National Inpatient Sample, adult US hospitalizations (2016-2022) with CIED-related infection requiring device removal were identified with International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Coding System codes. Hospitalizations were classified as CIED infection with same-admission reimplantation or CIED infection without same-admission reimplantation. Survey-weighted analyses estimated national incidence, temporal trends, and inflation-adjusted hospitalization costs. Multivariable survey-logistic regression identified predictors of infection and in-hospital mortality and evaluated organism-specific mortality among cases with coded pathogens.
RESULTS: Among approximately 1.2 million CIED implantation hospitalizations, 58,880 involved CIED infection requiring device removal (annual rate 0.024%; P for trend = .237). Same-admission reimplantation accounted for 31.2% of infections and declined over time, while hospitalizations without same-admission reimplantation increased to 71.4% (both P for trend = .0006). Congestive heart failure, atrial fibrillation, autoimmune disease, malnutrition, obesity, and peripheral arterial disease were independently associated with infection, whereas female sex was protective. Staphylococcal species were coded in 38.8% of infections; methicillin-resistant Staphylococcus aureus nearly doubled in-hospital mortality, whereas methicillin-susceptible S aureus was not independently associated with excess adjusted mortality. Adjusted in-hospital mortality for CIED infection hospitalizations increased from 4.6% to 6.0%, and inflation-adjusted mean costs for infection admissions had increased by 28.5%.
CONCLUSION: In this contemporary, nationally representative International Classification of Diseases, 10th Revision era cohort, the CIED infection rate requiring extraction remained low and stable at 0.024%, yet these events carried outsized clinical and economic consequences. Nearly 70% of infections were managed without same-admission reimplantation and occurred predominantly in patients with substantial multimorbidity, delineating a large, previously underrecognized population. Methicillin-resistant S aureus infections nearly doubled in-hospital mortality, whereas methicillin-susceptible S aureus, despite being more prevalent, was not independently associated with excess adjusted mortality. Infection-related hospitalization costs increased by almost 30% and rose 1.6-fold faster than costs for uncomplicated CIED implantations, indicating that CIED infections consume a disproportionate and accelerating share of healthcare resources.
OBJECTIVE: To characterize incidence, patient and hospital predictors, microbiology, in-hospital mortality, and costs of CIED infections requiring device removal stratified by same-admission reimplantation vs those without same-admission reimplantation.
METHODS: Using the National Inpatient Sample, adult US hospitalizations (2016-2022) with CIED-related infection requiring device removal were identified with International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Coding System codes. Hospitalizations were classified as CIED infection with same-admission reimplantation or CIED infection without same-admission reimplantation. Survey-weighted analyses estimated national incidence, temporal trends, and inflation-adjusted hospitalization costs. Multivariable survey-logistic regression identified predictors of infection and in-hospital mortality and evaluated organism-specific mortality among cases with coded pathogens.
RESULTS: Among approximately 1.2 million CIED implantation hospitalizations, 58,880 involved CIED infection requiring device removal (annual rate 0.024%; P for trend = .237). Same-admission reimplantation accounted for 31.2% of infections and declined over time, while hospitalizations without same-admission reimplantation increased to 71.4% (both P for trend = .0006). Congestive heart failure, atrial fibrillation, autoimmune disease, malnutrition, obesity, and peripheral arterial disease were independently associated with infection, whereas female sex was protective. Staphylococcal species were coded in 38.8% of infections; methicillin-resistant Staphylococcus aureus nearly doubled in-hospital mortality, whereas methicillin-susceptible S aureus was not independently associated with excess adjusted mortality. Adjusted in-hospital mortality for CIED infection hospitalizations increased from 4.6% to 6.0%, and inflation-adjusted mean costs for infection admissions had increased by 28.5%.
CONCLUSION: In this contemporary, nationally representative International Classification of Diseases, 10th Revision era cohort, the CIED infection rate requiring extraction remained low and stable at 0.024%, yet these events carried outsized clinical and economic consequences. Nearly 70% of infections were managed without same-admission reimplantation and occurred predominantly in patients with substantial multimorbidity, delineating a large, previously underrecognized population. Methicillin-resistant S aureus infections nearly doubled in-hospital mortality, whereas methicillin-susceptible S aureus, despite being more prevalent, was not independently associated with excess adjusted mortality. Infection-related hospitalization costs increased by almost 30% and rose 1.6-fold faster than costs for uncomplicated CIED implantations, indicating that CIED infections consume a disproportionate and accelerating share of healthcare resources.