A simple infection-control protocol to reduce serious cardiac device infections

Ahsan, Syed; Saberwal, Bunny; Lambiase, Pier D.; Koo, Chieh Yang; Lee, Simon; Gopalamurugan, A.B.; Rogers, Dominic; Löwe, Martin; Chow, Anthony

doi:10.1093/europace/euu126

Cited by 49 publications

(59 citation statements)

References 42 publications

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“…A single-institution study in England of 24 CDIs requiring device removal calculated a cost of €36,931 (£30,958) per CDI [19]. A study of CDI in seven pacemaker patients in Germany estimated a mean additional hospital cost of €7091 [20].…”

Section: Discussionmentioning

confidence: 99%

Incidence and costs of cardiac device infections: retrospective analysis using German health claims data

et al. 2018

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Aim: Estimate incidence and costs of cardiac device infections (CDIs) in Germany. Materials & methods:Patients had an implantable cardioverter defibrillator implanted over 2010-2013 and were followed to December 2014 using German health insurance claims data. A case-controlled analysis was performed using propensity score matching methods. Results: Risk of CDI 12 months post-implant was 3.4% overall, either 2.9% for de novo procedures versus 4.4% for replacement procedures. Mean 3-year incremental expenditure per patient for patients with CDI compared with controls was €31,493 for de novo implant patients and €33,777 for replacement patients. Mean incremental expenditure was €59,419 per patient with a major infection. Conclusion: CDIs are highly expensive to manage, reinforcing the need for strategies to reduce their occurrence. [1]. These devices are recommended for selected patients in guidelines from specialty medical societies and health technology assessment agencies [2][3][4]. There is an extensive body of evidence that demonstrates benefits including prolonged survival, improved quality of life and cost-effectiveness.Implantation of cardiac devices carries a risk of adverse events. These are classifiable as access-related (e.g., pneumothorax, hemothorax and hematoma), lead-related (e.g., perforation, displacement, fracture and endocarditis), generator-related (e.g., generator failure, migration and erosion) and pocket infection. Complete removal of all hardware is recommended in medical society guidelines and other scientific documents for patients with established cardiac device-related infection (CDI), and this includes cases in which a localized pocket infection occurs in the absence of signs of systemic infection, due to high relapse rates observed with retained hardware [5][6][7]. On the other hand, cardiac implantable electronic device (CIED) removal is not required for superficial or incisional infection at the pocket site if there is no involvement of the device.A large randomized controlled trial (DANISH study) recently reported an infection rate of 4.9% in a cohort of 556 ICD/CRT-D patients over a median follow-up of 5.6 years [8]. Serious device infections occurred in 2.7% of patients, defined as requiring lead extraction or lifelong antibiotic treatment or causing death. Worryingly, the number of CDI cases has been increasing: national healthcare data for the USA reported the number of hospitalizations due to CDI rose from 5308 in the year 2003 to 9948 in 2011 [9]. The increase is attributed to multiple factors including increased use of CRT devices (which have three leads and a higher risk of infection),

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Section: Discussionmentioning

confidence: 99%

Incidence and costs of cardiac device infections: retrospective analysis using German health claims data

et al. 2018

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“…The top cost categories in their series and in our study were both medical and surgical supplies (predominantly related to hardware device costs) and operating-room fees. Although there are no established comparison data for costs of DBS infection and explantation specifically, several series have reported the costs of cardiac implantable electrical device (CIED) infections [12,13]. Cardiac pacemakers are somewhat similar to DBS implants, because the implanted hardware and generator are also subject to infection and the need for removal.…”

Section: Discussionmentioning

confidence: 99%

Cost of Deep Brain Stimulation Infection Resulting in Explantation

Chen

Mirzadeh²,

Lambert³

et al. 2017

Stereotact Funct Neurosurg

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Background: Deep brain stimulation (DBS) hardware infection is a serious complication, often resulting in multiple hardware salvage attempts, hospitalizations, and long-term antibiotic therapy. Objectives: We aimed to quantify the costs of DBS hardware-related infections in patients undergoing eventual device explantation. Methods: Of 362 patients who underwent 530 electrode placements (1 January 2010 to 30 December 2014), 16 (4.4%) had at least 2 hardware salvage procedures. Most (n = 15 [93.8%]) required complete explantation due to recurrent infection. Financial data (itemized hospital and physician costs) were available for 13 patients and these were analyzed along with the demographic data. Results: Each patient underwent 1-5 salvage procedures (mean 2.5 ± 1.4; median 2). The mean total cost for a patient undergoing the median number of revisions (n = 2), device explantation, and subsequent reimplantation after infection clearance was USD 75,505; just over half this cost (54.2% [USD 40,960]) was attributable to reimplantation, and nearly one-third (28.9% [USD 21,816]) was attributable to hardware salvage procedures. Operating-room costs were the highest cost category for hardware revision and explantation. Medical and surgical supplies accounted for the highest reimplantation cost. Conclusions: DBS infection incurs significant health care costs associated with hardware salvage attempts, explantation, and reimplantation. The highest cost categories are operating-room services and medical and surgical supplies.

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“…Few studies have focused on the economic effects of TLE. Ahsan et al 15 studied 30 patients undergoing TLE for CIED infection in the UK reporting a mean cost of £30 958.40 for TLE and CIED replacement costs and a mean of 29.9±28.8 bed days per admission. In our cohort of patients undergoing TLE for infection (n=218), mean reimbursement cost was £18 963.89±£13 685.22 and mean LOS was 22.76±14.73 days.…”

Section: Discussionmentioning

confidence: 99%

Financial and resource costs of transvenous lead extraction in a high-volume lead extraction centre

Gould

Sidhu

Porter

et al. 2020

Heart

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ObjectivesTransvenous lead extraction (TLE) poses a significant economic and resource burden on healthcare systems; however, limited data exist on its true cost. We therefore estimate real-world healthcare reimbursement costs of TLE to the UK healthcare system at a single extraction centre.MethodsConsecutive admissions entailing TLE at a high-volume UK centre between April 2013 and March 2018 were prospectively recorded in a computer registry. In the hospital’s National Health Service (NHS) clinical coding/reimbursement database, 447 cases were identified. Mean reimbursement cost (n=445) and length of stay (n=447) were calculated. Ordinary least squares regressions estimated the relationship between cost (bed days) and clinical factors.ResultsMean reimbursement cost per admission was £17 399.09±£13 966.49. Total reimbursement for all TLE admissions was £7 777 393.51. Mean length of stay was 16.3±15.16 days with a total of 7199 bed days. Implantable cardioverter-defibrillator and cardiac resynchronisation therapy defibrillator devices incurred higher reimbursement costs (70.5% and 68.7% higher, respectively, both p<0.001). Heart failure and prior valve surgery also incurred significantly higher reimbursement costs. Prior valve surgery and heart failure were associated with 8.3 (p=0.017) and 5.5 (p=0.021) additional days in hospital, respectively.ConclusionsFinancial costs to the NHS from TLE are substantial. Consideration should therefore be given to cost/resource-sparing potential of leadless/extravascular cardiac devices that negate the need for TLE particularly in patients with prior valve surgery and/or heart failure. Additionally, use of antibiotic envelopes and other interventions that reduce infection risk in patients receiving transvenous leads should be considered.

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A simple infection-control protocol to reduce serious cardiac device infections

Abstract: A significant reduction in CDI can be achieved with the introduction of a simple ICP with substantial cost savings.

Cited by 49 publications

References 42 publications

Incidence and costs of cardiac device infections: retrospective analysis using German health claims data

Incidence and costs of cardiac device infections: retrospective analysis using German health claims data

Cost of Deep Brain Stimulation Infection Resulting in Explantation

Financial and resource costs of transvenous lead extraction in a high-volume lead extraction centre

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