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Patient Demographics, Complications, and Hospital Utilization in 250 Consecutive Device Implants in a New Community Hospital Electrophysiology Program— Implications for 'Niche' Hospitals
Jeffrey L Williams, David Lugg, Robert Gray, Douglas Hollis, Michelle Stoner and Robert Stevenson,
American Heart Hospital Journal Volume 8 No.1
Background: Single-center reports on patient demographics and early (< 6 weeks) device complication rates in academic hospitals are scant and non-existent for non-academic community hospital electrophysiology (EP) programs. Objective: The objective of our study was to examine the demographics, complications, re-admissions, and accessibility of care in a community EP program to add to the body of knowledge of 'real-world' defibrillator implant complications.
Methods:
Two hundred and fifty consecutive patients who underwent device implantation by a single electrophysiologist in a new non-academic community hospital EP program starting from its inception in July 2008 were included for analysis. Standard procedures for implantation were used. Pacemakers, defibrillators, and generator changes were included; temporary pacemakers were excluded. Major complications were defined as in-hospital death, cardiac arrest, cardiac perforation, cardiac valve injury, coronary venous dissection, hemothorax, pneumothorax, transient ischemic attack, stroke, myocardial infarction, pericardial tamponade, and arteriovenous fistula. Minor complications were defined as drug reaction, conduction block, hematoma or lead dislodgement requiring re-operation, peripheral embolus, phlebitis, peripheral nerve injury, and device-related infection.
Results:
This community cohort had similar ejection fractions but was older with worse kidney function than those studied in prior reports. There was one major early complication (0.4%) and seven minor early complications (2.8%). Left ventricular lead placement was successful in 64 of 66 patients (97%).
Conclusions:
This is the first community-hospitalbased EP program to examine device implant demographics and outcomes, and revealed an elderly, ill population with lower overall rates of complications than seen in national trials and available reports from single non-community centers. Contrary to current perceptions, these data suggest that community centers may subselect an elderly, ill patient population and can provide high-quality, cost-effective, and more accessible care.
There are reports that community hospitals have lower-risk, less ill patients compared with noncommunity centers.1,2 It is also suggested that non-community centers have better outcomes for a variety of conditions.3,4 Finally, Medicare provides non-community hospitals (e.g. academic teaching hospitals) more reimbursement than it costs to care for patients via indirect and direct medical education adjustments to account for treating 'sicker' patients.5,6
Single-center reports on patient demographics and early (< 6 weeks) device complication rates in non-community hospitals are scant and non-existent for non-academic community hospital electrophysiology (EP) programs. A newly established clinical cardiac EP program sought to be the first community hospital-based program to examine the demographics, complications, and re-admission rates associated with the initial 250 consecutive device implant patients.
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