TY - JOUR
T1 - Complications of cardiac implantable electronic device placement in public and private hospitals
AU - Ganesan, Anand
AU - Moore, Katherine
AU - Horton, Dennis
AU - Heddle, William
AU - McGavigan, Andrew D.
AU - Hossain, Sadia
AU - Ali, Anna
AU - Hariharaputhiran, Saranya
AU - Ranasinghe, Isuru
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Background: Few 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. Aims: To report comparative complications of cardiac implantable electronic device (CIED) placement in public and private hospitals. Methods: We 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. Results: A 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. Conclusions: These data identify important similarities and differences in safety outcomes of CIED implantation between Australian public and private hospitals.
AB - Background: Few 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. Aims: To report comparative complications of cardiac implantable electronic device (CIED) placement in public and private hospitals. Methods: We 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. Results: A 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. Conclusions: These data identify important similarities and differences in safety outcomes of CIED implantation between Australian public and private hospitals.
KW - complication
KW - defibrillator
KW - pacemaker
KW - private hospital
KW - public hospital
UR - http://www.scopus.com/inward/record.url?scp=85087307749&partnerID=8YFLogxK
U2 - 10.1111/imj.14704
DO - 10.1111/imj.14704
M3 - Article
C2 - 31762133
AN - SCOPUS:85087307749
SN - 1444-0903
VL - 50
SP - 1207
EP - 1216
JO - Internal Medicine Journal
JF - Internal Medicine Journal
IS - 10
ER -