ACC: Device-related infection amplifies cost, mortality

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NEW ORLEANS—Surgical-related infections associated with pacemakers and implantable cardiac defibrillator (ICD) implantation increased mortality rates eight- to 11-fold and were associated with 55 to 118 percent higher hospitalization costs, according to a poster presentation this morning at the American College of Cardiology scientific sessions.

In addition, these surgical infections increased hospital length of stay three-fold, and one-third of the deaths related to these infections occurred after hospital discharge.

The study looked at data from more than 200,000 Medicare patients undergoing device implantation with and without infection to evaluate the excess costs and mortality associated with device infection.

“What we found is that infection of a cardiac device compared with procedures performed without infection have a significant impact on length of stay, cost and mortality,” M. Rizwan Sohail, MD, lead author of the study and associate professor of Medicine at the Mayo Clinic College of Medicine in Rochester, Minn., said in an interview.

Sohail noted that an interesting finding was the fact that the highest costs were linked to patients’ stay in the intensive care unit. He offered that in the future, strategies that cut patients' time in the ICU, like placing them in telemetry units, could help reduce costs. Additionally, he offered that a shorter time between device-related implantation could be beneficial and actually reduce costs. Rather than waiting five to seven days, Sohail said that it has proven that it is feasible to place a device within 72 hours.

“The increase of the risk of death continues even after hospital discharge,” said Sohail. He claimed that there should be a more assertive effort by intermediate care settings, like nursing homes, where Medicare patients are often released, to monitor patients more closely.

Additionally, Sohail et al found that longer term morality rates were 27 to 36 percent, almost two-fold the rate without device infection. Lastly, the cost to treat these types of device infections ranged from $17,000 for pacemaker infections to $25,600 for certain defibrillator types. These costs could exceed almost $1 million.

The most common types of infections were skin infections, which accounted for two-thirds of the infections found. One-third of these were blood-stream infections.

In terms of preventing these infections, Sohail said that in the future clinicians must ensure that these device procedures are performed in a sterile environment without the risk of device contamination. Secondly, Sohail offered that it may be beneficial to administer antibiotics at the time of device implantation, as previous studies have shown that this significantly reduces a patient’s risk of infection.

Sohail said that future studies should evaluate the risk factors associated with these patients (those with infection) and why these patients are at such a high risk of death after they are discharged from the hospital compared to patients who undergo the same procedures with the same devices.

“Also, it is important to ensure that the interventions are used sparingly because as you increase the number of procedures or modify the device, the higher the risk,” Sohail noted.

“The key message we want to get out is that infection is associated with a substantial increase of cost and mortality and that there are ways to reduce these costs,” concluded Sohail. “Because healthcare costs are a major issue in medicine, more work needs to be done to identify ways in which costs can be reduced.”