Impact of Hospital Lead Extraction Volume on Management of Cardiac Implantable Electronic Device-Associated Infective Endocarditis

Background: Utilization of transvenous lead extraction/removal (TLE) for the management of cardiac implantable electronic device (CIED)-associated infective endocarditis (IE) remains low.

Objective: To examine the impact of hospital TLE procedural volume on TLE utilization and outcomes for patients with CIED-associated IE.

Methods: Using the Nationwide Readmissions Database, we evaluated 21,545 admissions for patients (mean age 70, 39% female) with CIEDs hospitalized with IE at TLE centres. Hospitals were categorized based on annual volume tertiles: 1) low volume (1-17 TLEs/year) 2) medium volume (18-45 TLEs/year) and 3) high volume centres (>45 TLEs/year).

Results: Between 2016 and 2019, 57% of admissions in the study were to low volume TLE centres. TLE was performed during 6.9%, 19.3% and 26% of admissions for CIED-associated IE at low, medium and high volume TLE centres, respectively (P< 0.001). After adjustment for age and co-morbidities, hospitalization for IE at high volume centres was independently associated with TLE when compared to low volume centres (aOR 4.26; 95% CI 3.53-5.15). TLE extraction-associated complication rates were similar at 2.5%, 2.3% and 3.4% at low, medium and high centres, respectively (P = 0.493). Overall inpatient mortality during admissions to low, medium and high-volume centres was also similar.

Conclusions: Admissions to high volume TLE centres was associated with higher utilization of TLE for management of CIED-associated IE. TLE-associated complications and mortality among patients hospitalized with CIED-associated IE were similar when stratified by hospital TLE volume, but needs to be considered in context of significant differences in patient co-morbidity burden between centres.