Thirty-day readmissions after cardiac implantable electronic devices in the United States: Insights from the Nationwide Readmissions Database

Heart Rhythm. 2018 May;15(5):708-715. doi: 10.1016/j.hrthm.2018.01.006. Epub 2018 Jan 6.

Abstract

Background: Limited data are available regarding true estimates of individual complications contributing to readmissions after cardiac implantable electronic device (CIED) implantation.

Objective: The purpose of this study was to identify predictors of 30-day readmission in patients admitted for CIED implantation.

Methods: The study cohort consisted of patients who underwent CIED implantation in 2014, identified from the National Readmission Database. Readmission was defined as a subsequent hospital admission within 30 days after the discharge day of index admission. If patients had more than 1 readmission within 30 days, only the first readmission was included.

Results: Our final cohort consisted of 70,223 cases, 61,738 (88%) in the no-readmission group and 8485 patients (12%) in the readmission group. Female gender (odds ratio [OR] 1.09; 95% confidence interval [CI] 1.04-1.14; P = .001), atrial fibrillation/flutter (OR 1.23; 95% CI 1.17-1.29, P <.001), acute renal failure (OR 1.65; 95% CI 1.56-1.74; P <.001), coronary artery disease (OR 1.09; 95% CI 1.03-1.14; P = .002), length of stay (OR 1.70; 95% CI 1.51-1.89; P <.001), device placement on the day of admission (OR 0.87; 95% CI 0.80-0.95, P = .001), and fourth quartile of hospital procedure volume (OR 0.91; 95% CI 0.84-0.99; P = .03; first quartile of hospital procedure volume as reference) were independent predictors of 30-day readmissions. The 30-day readmission resulted in additional median charges of $30,692 per patient. Device-related complications were seen in 10.7% of readmitted patients. The most common complications were mechanical (2.8%) and infectious (2.6%).

Conclusion: Several patient and hospital-related factors were identified to be independent predictors of 30-day readmission, accounting for increased health care cost.

Keywords: Cardiac implantable electronic device; Cost; Health care; Nationwide Readmission Database; Readmission.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Arrhythmias, Cardiac / economics
  • Arrhythmias, Cardiac / epidemiology
  • Arrhythmias, Cardiac / therapy*
  • Databases, Factual
  • Defibrillators, Implantable*
  • Female
  • Follow-Up Studies
  • Health Care Costs / statistics & numerical data*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Pacemaker, Artificial*
  • Patient Readmission / economics
  • Patient Readmission / trends*
  • Registries*
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • United States / epidemiology
  • Young Adult