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Costs and complications associated with transvenous lead reoperation in cardiac implantable electronic devices
Author(s) -
Griffiths Robert I.,
Amorosi Stacey L.,
Jacobsen Caroline M.,
McBee Patrick J.,
Menzin Joseph,
Reynolds Matthew R.
Publication year - 2020
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.14337
Subject(s) - medicine , lead (geology) , confidence interval , odds ratio , surgery , emergency medicine , multivariate analysis , geology , geomorphology
Background Cardiac implantable electronic device transvenous (TV) lead reoperations are projected to increase, and robust economic data are needed to assess the resulting financial impact and the cost‐effectiveness of prevention and treatment strategies. This study estimates Medicare costs, and describes patterns of complications, in patients who underwent TV lead reoperation. Methods and Results Medicare data (2010‐2014) were used to identify patients who underwent TV lead reoperation. Cumulative costs to Medicare, and rates of infection and mechanical complications were calculated from 180 days before, to 180 days after, lead reoperation. Multivariate analysis was used to estimate adjusted costs, and to examine the impact of complications on medical resource use and costs. There were 1691 patients, 63.2% of whom underwent inpatient lead reoperation. Overall, the mean age was 78.2 years, 39.6% were female, and 92.3% were white. The mean cumulative cost was $36 199 (95% confidence interval [CI], $31 864‐$40 535) for TV lead repositioning, $27 701 (95% CI, $19 869‐$35 534) for repair, and $54 442 (95% CI, $51 651‐$57 233) for removal. Underlying infection was associated with increased odds of inpatient reoperation and of lead removal, as well as longer length of stay and higher costs. Conclusions The economic consequences of TV lead reoperation are substantial. Strategies aimed at reducing reoperation, particularly lead removal, are likely to result in considerable cost offsets.