• Internal medicine journal · Oct 2020

    Observational Study

    Complications of cardiac implantable electronic device placement in public and private hospitals.

    • Anand N Ganesan, Katherine Moore, Dennis Horton, William Heddle, Andrew D McGavigan, Sadia Hossain, Anna Ali, Saranya Hariharaputhiran, and Isuru Ranasinghe.
    • College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
    • Intern Med J. 2020 Oct 1; 50 (10): 1207-1216.

    BackgroundFew safety data exist comparing clinical outcomes in Australian public and private hospitals. We hypothesised that differences could exist between public and private hospitals due to differences in acuity and patient-level co-morbidities.AimsTo report comparative complications of cardiac implantable electronic device (CIED) placement in public and private hospitals.MethodsWe conducted an observational cohort study of outcomes of patients aged >18 years from 2010 to 2015 undergoing a new permanent pacemaker (PPM), implantable cardioverter defibrillator (ICD) or cardiac resynchronisation therapy pacemaker or defibrillator (CRT-D/P) implant in NSW and Queensland public and private hospitals. The primary endpoint was major CIED-related complications occurring in-hospital or within 90 days of discharge. The independent effect of hospital sector was determined using multiple logistic regression, adjusting for covariates, including age, sex, co-morbidities and procedural acuity.ResultsA total of 32 364 new CIED implants (PPM 23 845, ICD 5361 and CRT-D/P 3158) were included (49% in private hospitals). Overall, 8.0% of private hospital procedures and 9.6% public hospital procedures experienced at least one complication. After adjustment, the overall risk of CIED complications was similar in private and public hospitals (OR: 0.92, 95% CI: 0.84-1.00, P = 0.06). In analysis of individual complications, adjusted all-cause in-hospital mortality was higher in private hospitals, (OR: 1.49, 95% CI: 1.03-2.16, P = 0.036) primarily driven by an excess mortality in acute cases. The adjusted risk of in-hospital generator operation (OR: 0.53, 95% CI: 0.30-0.94, P = 0.03) and post-discharge infection (OR: 0.61, 95% CI: 0.46-0.81, P < 0.001) was lower in private hospitals.ConclusionsThese data identify important similarities and differences in safety outcomes of CIED implantation between Australian public and private hospitals.© 2019 Royal Australasian College of Physicians.

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